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ica 



Support 




MEDICAL SUPPORT OF THE ARMY AIR FORCES 
IN WORLD WAR II 




General of the Army Henry H. Arnold. 



Department of the Air Force 



MEDICAL SUPPORT 
of 

THE ARMY AIR FORCES 
IN WORLD WAR II 

by 

Mae Mills Link 
Hubert A. Coleman 



Office of the Surgeon Generalj USAF 
Washington, £>. C v 1955 



Library of Congress Catalog Card Number: 55-60024 



CREDIT must be given to the Surgeon General, US AF, for quotation or repro- 
duction of any material from this volume. The Department of the Air Force 
wishes to acknowledge its appreciation to the following publishers for permis- 
sion to quote copyrighted materials: Alfred A. Knopf, Inc. (Eric Sevareid, 
Not So Wild A Dream, 1946); J. B. Lippincott Co. (Isaac H. Jones, Flying 
Vistas, 1937); Josiah Macy, Jr. Foundation (Grinker and Spiegel, War Neuroses 
in North Africa, 1943); The University of Chicago Press (Craven and Cate, 
editors, The Army Air Forces in World War II, Vol. IV, 1950 and Vol. V, 1955); 
and Williams and Wilkins (H. G. Armstrong, Principles and Practice of Aviation 
Medicine, 3d Edition, 1952). 



Foreword 



The problems we have overcome in this war will not differ from possible problems of the future. 
The solutions will come from the things we have learned in this war. There will be nothing 
new facing us that has not already been answered in principle if not in practice. 

It is in keeping with the spirit of these words of Gen. Henry H. Arnold, Com- 
manding General of the Army Air Forces, that Medical Support of the Army Air Forces 
in World War II has been prepared. This monumental task fell to Mae Mills Link, 
Ph. D., senior medical historian in the United States Air Force, and Hubert A. Cole- 
man, Ph. D., Professor of History at East Carolina College, who held a comparable 
position in the AAF during World War II. 

Maj. Gen. David N. W. Grant, USAF (MC) (Ret), the wartime Air Surgeon, 
and Maj. Gen. Malcolm C. Grow, USAF (MC) (Ret), first Surgeon General, USAF, 
have read painstakingly through the final version. Brig. Gen. Richard Meiling, 
USAF (MC) (R), who was closely associated with the Air Surgeon's Office during 
the war, has given generously of his time in an advisory capacity. Likewise, Brig. 
Gen. Albert H. Schwichtenberg, USAF (MC), who was the Air Force liaison officer 
in the Army Surgeon General's Office, has read and commented upon the section 
dealing with that complicated relationship. To them all I extend my very warm 
personal thanks. I wish also to express my appreciation to Ma). Gen. Howard 
McCrum Snyder (USA) (Ret), Gen. George C. Marshall's wartime Assistant to the 
Inspector General for Medical Affairs, for his time and patience when interviewed 
by the Historian. Col. Wildred J. Paul, USAF, Director, Research Studies Institute, 
Air University, Dr. Albert F. Simpson, Air Force Historian, Mr. Joseph W. Angell, 
Jr., USAF Historical Division, and Lt. Col. Eldon W. Downs, USAF, Air University 
Historical Liaison Officer, by their unfailing support have sustained us through the 
long and arduous task of historical research. 

In the final analysis, however, credit for the present volume must rest with the 
uncounted numbers of medical service officers and men who actually made military 
medical history at their posts throughout the world. It is to them, therefore, that 
this volume is dedicated. 

Dan C. Ogle, 
Maj. Gen., USAF (MC), 
30 July 1954 Surgeon General. 



[v] 



The Flight Surgeons Oath 



/ accept the sacred charge to assist in the healing of the mind as well as 
of the body. 

I will at all times remember my responsibility as a pioneer in the new and 
important field of aviation medicine. I will bear in mind that my studies an 
unending; my efforts ceaseless; that in the understanding and performance of 
my daily tasks may lie the future usefulness of countless airmen whose training 
has been difficult and whose value is immeasurable. 

My obligation as a physician is to practice the medical art with upright- 
ness and honor; my pledge as a soldier is devoted to Duty, Honor, Country. 

I will be ingenious. I will find cures where there are none; I will call 
upon all the knowledge and skill at my command. I will be resourceful; I will, 
in the face of the direst emergency, strive to do the impossible. 

What I learn by my experiences may influence the worlds not only of today, 
but the air world of tomorrow which belongs to aviation. What I learn and 
practice may turn the tide of battle. It may send back to a peacetime world the 
future leaders of this country. 

I will regard disease as the enemy; I will combat fatigue and discourage- 
ment as foes; I will keep the faith of the men entrusted in my care; 1 will keep 
the faith with the country which has singled me out, and with my God. 

I do solemnly swear these things by the heavens in which men fly. 



[vii] 



Preface 



Medical Support of the Army Air Forces In World War II has been 
prepared to fill a gap in the medical history of that period. Its pur- 
pose is to present a unified narrative of the total performance of the 
AAF medical service in support of the Air Forces combat mission. 
Fundamentally a reference book, this volume is based almost exclu- 
sively upon unpublished documents in custody of the U. S. Air Force, 
with occasional citation of published sources. 

Since this volume, like other comparable military publications in 
World War II, is based upon masses of archival material, the project 
has been in a very true sense a group project. During World War II 
professionally trained historians carried out basic research and writing 
while professional specialists in aviation medicine prepared highly 
technical materials. And while as authors we must assume final re- 
sponsibility for the historical and technical accuracy of the presenta- 
tion and interpretation of the present volume, it has been our intention 
insofar as is humanly possible to establish and acknowledge individual 
contributions. In the order of sequence in which these group efforts 
appear, first mention is made of Chapter III, * 'School of Aviation and 
Related Programs' ' which represents a collation of edited data based 
upon the series of 6-month histories prepared in the Army Air Forces 
Training Command under the direction of Col. Neeley Mashburn (MC), 
by the School of Aviation Medicine, and by the four continental air 
forces. Chapter IV, 4 'Research and Development' * represents in part 
a collation of materials from the same source, together with a draft 
prepared by the staff of the Aero Medical Laboratory. Chapter V, 
"The Air Evacuation Mission" is a collation of data gathered from 
the histories of the School of Air Evacuation, the School of Avia- 
tion Medicine, and the Wing histories of the Air Transport Command. 
None of these chapters represents original research or writing on the 
part of the editors. The overseas theaters, on the other hand, have 
been approached somewhat differently. Two historians on the war- 
time staff were originally scheduled to prepare monographs on the 



[ix] 



Mediterranean and European Theaters respectively. John S. G. Car- 
son, Ph. D., who was to prepare the final draft of the AAF/Mediter- 
ranean Theater medical history was called back to his academic post 
before his research and writing was completed. Chapter VI, how- 
ever, incorporates much of his draft material. It also includes, with 
minor editing, a section on the North African Landings and early 
Twelfth Air Force prepared in the theater under the direction of Col. 
William Cook (MC). Another Headquarters historian, Wiley Hodges, 
Ph. D., was scheduled to prepare a monograph on the European Thea- 
ter but he too was called back to his academic post before his task 
was completed. A large section of Chapter VIII dealing with the 
"Special Problems of Aviation Medicine in Europe", however, remains 
substantially as written by him. The section on the Ninth Air Force, 
with slight editing, incorporates the periodic histories prepared in the 
theater. And while the editors have taken extensive liberties with 
his manuscript, authorship credit for the chapter on the Pacific and 
Southwest Pacific belongs to Lt. Col. Charles G. Mixter, Jr. (MC) 
who was Malaria Control Officer in that area during the war and later 
called to Headquarters, AAF, to prepare the official report. Finally 
to Bruce Berman, M. A., who is presently a member of the historical 
staff, goes collaborative credit in preparation of the chapter on China- 
Burma-India. This is in addition to his assistance in editing the 
volume. 

Because of space limitations it was decided arbitrarily not to 
include three important programs. The AAF Psychological Program 
had already been treated in the definitive 19-volume series published 
under the title, The Aviation Psychology Program in the AAF. The manu- 
script history on surgery prepared by Col. Alfred R. Shands, Jr. (MC), 
Maj. James V. Luck (MC), Maj. Hugh M. A. Smith (MC), and Lt. Col. 
Henry B. Lacey (MC), was of such a specialized nature that it was 
believed advisable to publish that material as a separate monograph 
at some future date. Likewise it was considered desirable that a 
separate monograph discuss the operation of Army Air Forces hospi- 
tals in the Zone of Interior during the period of mobilization and 
demobilization. This decision was based on the fact that the central 
theme of the present volume was support of the combat mission, and 
it seemed proper to concentrate upon policy decisions at AAF Head- 
quarters level rather than upon operational details of the many Army 
Air Forces installations in the Zone of Interior. 



M 



The volume has thus attempted to portray in detail the problems 
faced by the AAF and the measures taken to solve them. To the lay 
reader it may appear that there is too much detail in treating certain 
events when a summary statement would have been sufficient. Since, 
however, it is hoped that this history will provide a basic reference 
for younger officers who may again be faced with similar problems 
we concluded that the processes by which certain policy decisions were 
reached should be described step by step. Because certain of these 
decisions were based upon factors other than those over which the 
Army Air Forces had control, however, it is suggested that as supple- 
mentary reading the medical history series, in preparation by the 
Army Surgeon General, be consulted, and that the official Air Force 
history be kept close at hand as a reference. 

A word is necessary at this point to explain certain editorial and 
military usages. Spelling and numbers in the text for the most part 
follow the rules of the Government Printing Office Style Manual. 
Titles of frequently used military organizations such as the Army Air 
Forces are sometimes spelled out and other times abbreviated to prevent 
endless repetition within a paragraph. Military rank is, of course, 
always a thorny problem for the editor. In this volume, the highest 
rank attained by an officer is used in the prefatory and concluding 
remarks; in the text the rank held at the time of the event is used 
even though it may sometimes be confusing. Military time (i. e. 
1600) is always used. Another difficult problem has been that of 
reconciling statistical information. Because reports are not always 
based upon the same reporting period there may sometimes be minor 
inconsistencies. It is believed, however, that units within a theater 
or at Headquarters are uniform and reflect as accurate presentation as 
possible. Sources of tabular information are documented either on 
the table or in the body of the text. 

In the writing of medical history of the Air Force the historian is 
sometimes called upon to use highly technical terms (i. e. aero- 
embolism). At the same time the writing of military history requires 
the use of cumbersome terms which must be endlessly repeated but 
which when reduced to symbols defy the understanding of the average 
reader (SCAT and COMAIRSOLS). In addition, the military vocabu- 
lary is often overladen with ponderous cliches which bog down the 
narrative (the "over-all situation"). Both as historians and as 
editors we have been aware that we have not been able to overcome 



[xil 



these impedimenta of the narrative. As one device, however, words 
or phrases that are used a great deal (such as Army Air Forces) have 
been interposed with their symbols (AAF) to avoid complete monotony 
through repetition. 

Finally, we would like to make mention of the splendid cooper- 
ation on the part of the key military personnel involved as well as all 
others who have contributed to the volume. Major General Grant 
wrote: "I am only interested in a history being written based on 
factual data, with criticism falling where it may, even though I am 
directly the one being criticized/ ' Major General Grow who suc- 
ceeded him as Air Surgeon in 1946 and whose prior experiences in the 
Air Corps and later in the European Theater are treated in detail, has 
likewise responded magnificiently. Major General Armstrong, scholar 
without peer in the field of aviation medicine, and Surgeon General in 
the period when the volume went to press, was, despite his heavy 
burden of duty, unfailingly helpful. Never in any manner did he 
attempt to modify the independent conclusions or observations of the 
historians. In addition to the expert advice of Generals Meiling and 
Schwichtenberg, we would like to acknowledge that of Brig. Gen. 
H. H. Twitchell (MC) who was Twentieth Air Force Surgeon, Brig. 
Gen. Otis O. Benson (MC), who was Director of the Aero Medical 
Laboratory and later Surgeon of the Fifteenth Air Force and AAF/Med- 
iterranean Theater, Brig. Gen. Clyde L. Brothers (MC), who was 
Tenth Air Force Surgeon and later AAF/CBI Surgeon, Col. Jay F. 
Gamel (MC), who was Tenth Air Force Surgeon, Col. Robert J. 
Benford (MC), XX Bomber Command Surgeon, Col. Donald D. 
Flickinger (MC), CBI Wing Surgeon for Air Transport Command, 
Col. Robert C. Love (MC) who was a member of the Air Surgeon's 
wartime staff and Col. Adolph P. Gagge (MSC) who pioneered re- 
search in oxygen equipment at the Aero Medical Laboratory during 
World War II. These officers all have aided substantially in advising 
us within the area of their wartime experience. 

Their assistance, however, would have served little purpose had 
it not been for the unfailing support of our day-to-day activities 
within the Executive Office. Maj. Gen. Dan C. Ogle (MC), the 
Surgeon General, who was Deputy Surgeon General while the volume 
was in preparation, and Brig. Gen. William H. Powell, Jr. (MC), his 
successor as Deputy, were available for counsel at all times; and with- 
out the sympathetic and constructive support of Lt. Col. William M. 



[xii] 



Johnson (MSC), Executive Officer for the Surgeon General, the hur- 
dles to be overcome would have been unsurmountable. We wish also 
to acknowledge our indebtedness to Col. Clayton G. Weigand (MC), 
upon whom fell the task of organizing and directing the medical his- 
tory program within the military framework of the Air Surgeon's 
Office during World War II. Our warmest tribute goes to Mrs. Roma 
J. Dawson for her patience and endurance in the almost endless task 
of supervising all typing for the project and for assumption of edito- 
rial responsibility, as well as to Miss Ima Lee who bore a similar 
burden during the war. We are deeply indebted to personnel — both 
military and civilians — of the Publishing Division, Air Adjutant Gen- 
eral, for their excellent cooperation and assistance during the publish- 
ing of this document. We are especially grateful to Mr. Walter Ivan 
Smalley who performed the final editing and preparation of manu- 
script prior to publication. And to those unseen members of the 
Government Printing Office whose patience we must so often have 
strained goes our very sincere thanks. 

Like the Surgeon General, however, we recognize that final credit 
properly belongs to the medical service officers, nurses, and men who 
were there when duty called. 

MAE MILLS LINK 
HUBERT A. COLEMAN 

30 July 1954 
Washington, D. C. 



[xiii] 



Contents 

Chapter P a &* 

INTRODUCTION 1 

I. ORIGINS OF AN AIR FORCE MEDICAL SERVICE 6 

Evolution of a Physical Examination for Flyers 6 

Establishment of Medical Research Laboratory 11 

Medical Support of Combat Mission in World War 1 13 

The Interim Years 20 

Transition from Peace to War 24 

II. THE WAR MISSION 45 

The Issues Emerge: 1942 50 

The Issues Are Clarified: 1943 67 

The Mounting Crisis: 1944 83 

The Issues Are Partially Resolved: 1944. . . . 91 

Mission Accomplished: 1945 114 

III. SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS. 144 

The School of Aviation Medicine 145 

The War Curriculum: SAM 159 

Advanced Study for Altitude Training 196 

Implementing the Altitude Training Program in the AAF 210 

Air-Sea Rescue Training 218 

Medical Service Training School 219 

IV. RESEARCH AND DEVELOPMENT 230 

Anthropology 238 

High Altitude Studies 253 

Acceleration 283 

Medical Logistics 295 

Medical Instrumentation 303 

Clinical Aspects of Aviation Medicine 305 

Among the Heroes 340 

V. AIR EVACUATION MISSION 35Z 

The 349th Air Evacuation Group 366 

The Flight Nurse 368 

AAF School of Air Evacuation 371 

Air Evacuation to Zone of Interior 383 

Contribution to Military Medicine 410 

VI. MEDICAL SUPPORT OF AIR COMBAT IN NORTH AFRICA AND 

THE MEDITERRANEAN 419 

Twelfth Air Force and TORCH 419 

The Tactical Situation 424 

Case History: 434th Bombardment Squadron 430 

Establishment of Army Air Forces, Mediterranean Theater of Operations . 438 



[XV] 



Chapter Page 

VI. MEDICAL SUPPORT OF AIR COMBAT IN NORTH AFRICA AND 
THE MEDITERRANEAN — Continued . 

Personnel 448 

Hospitalization 455 

Air Evacuation 473 

Special Problems of Aviation Medicine: Twelfth and Fifteenth Air Forces . 493 

Health and Fighting Effectiveness .... 508 

VII. MEDICAL SUPPORT OF AIR COMBAT IN EUROPE 528 

The Early Period 529 

The Eighth Air Force 534 

First Echelon Medical Service for Air Combat Crews 543 

Eighth Air Force Central Medical Establishment 547 

Medical Support of the Early Combined Bomber Offensive 555 

Medical Support of United States Strategic Air Forces in Europe 559 

Hospitalization Crisis: Spring 1944 563 

Medical Staffing 571 

Air Support of Ground Forces: Ninth Air Force 588 

Air Evacuation 598 

VIII. SPECIAL PROBLEMS OF AVIATION MEDICINE IN EUROPE. . . 617 

Protective Armor 617 

Cold Injuries 635 

Anoxia 647 

Aero-otitis 655 

Stress 660 

Disposition 670 

Health and Fighting Effectiveness 680 

Injuries and Wounds 692 

AAF Aero Medical Center 708 

United States Strategic Bombing Survey in Germany 710 

IX. MEDICAL SUPPORT OF AIR COMBAT IN THE PACIFIC 725 

Hospitalization 736 

The Central Medical Establishment 751 

Convalescence and Rehabilitation 756 

Medical Supply 760 

Air Evacuation 766 

AAF Dental Program: Case History 789 

Health and Fighting Effectiveness 793 

Sanitation 822 

Terrain Factors 827 

Native Population Factor 828 

Special Problems in Aviation Medicine 830 

Nutrition as a Health Factor 838 

Stress 847 

Disposition 856 

X. MEDICAL SUPPORT OF AIR COMBAT IN CHINA-BURMA-INDIA . 875 

The Early Period 876 



[xvi] 



Chapter Page 

X. MEDICAL SUPPORT OF AIR COMBAT IN CHINA-BURMA-INDIA— 

Continued. 

Tenth Air Force 886 

India-Burma Theater 898 

Health and Fighting Effectiveness: Tenth Air Force and AAF India- 
Burma Theater 900 

Fourteenth Air Force and AAF China Theater 902 

Health and Fighting Effectiveness: AAF China Theater 907 

XI. MEDICAL SUPPORT OF THE VERY LONG RANGE (VH) 

BOMBER PROGRAM 92 

Organising the Medical Service of the XX Bomber Command 926 

XX Bomber Command Moves to India 929 

China Bases 932 

Air Evacuation and Rescue 935 

Health and Fighting Effectiveness: China-Burma-India 944 

Withdrawal to the Pacific 947 

XX/ Bomber Command 949 

Special Problems of Aviation Medicine 955 

Health and Fighting Effectiveness: Marianas 958 

The Final Days 964 

U. S. Strategic Bombing Survey in Japan 965 

POSTSCRIPT 971 

GLOSSARY 977 

INDEX 981 

Tables 

No. Page 

1. Procurement of Medical Corps Officers for Duty With the Army Air Forces 

from August 1942-December 1942 56 

2. Procurement of Medical Corps Officers for Duty With the Army Air Forces 

from December 1942 Through December 1943 59 

3. Nurses Assigned by the Nursing Section, Office of the Air Surgeon 60 

4. Number of Medical Department Officers on Duty With the Army Air 

Forces Whose Separations Orders Had Been Received by the Office of 

the Air Surgeon from V-E Day to 29 January 1946 134 

5. Course Hours Schedule 148 

6. The School of Aviation Medicine Graduates 153 

7. Instruction Surgical Subjects, AAFSAM 1936-1946. 173 

8. AME Students From Overseas 187 

9. Medical Examiner Ratings 189 

10. Aviation Medical Examiner Graduates, August 1940-September 1945. . . . 190 

11. Failures AME Course in Fiscal Year; 1941-1945 191 

12. Didactic Grades by 3- Year Age Groups 191 

13. Extension Course Fiscal Years 1941-1945 194 

14. Unit Oxygen Officer Graduates 208 

262297 55 2 [ xv " ] 



No. Page 

15. Altitude Chamber Flights 216 

16. Major Surveys of the Army Air Forces Anthropological Projects 243 

17. Medical Technicians Graduated from the Course at the School of Aviation 

Medicine from November 1944 to October 1945 381 

18. Number of Patients Evacuated Within the United States from October 1944 

Through May 1946 382 

19. Distribution of 1,172,648 Air Evacuees by Theater With Death Rates in 

Flight per 100,000 Patients (January 1943-May 1945) 399 

20. Hospitals Attached to Twelfth Air Force 471 

21. Evacuation in the Tunisian Campaign Ending 23 May 1943 480 

22. MTO Air Evacuation, September 1943-December 1943 486 

23. Patients Evacuated by Month in the Mediterranean Theather of Opera- 

tions, 1944 487 

24. Percentages of Patients Evacuated by Category in the Mediterranean 

Theater of Operations, 1944 488 

25- Patients Evacuated by Months in the Mediterranean Theater of Operations, 

1945 489 

26. Percentages of Patients Evacuated by Category in the Mediterranean 

Theater of Operations, 1945 490 

27. Check Points in Effect in the Twelfth Air Force, 1943 500 

28. Probabilities of Survival in the Twelfth Air Force, 1944 500 

29. Cases Appearing Before the Medical Disposition Board of the Twelfth Air 

Force 501 

30. Fifteenth Air Force Medical Disposition Board Cases, 1944 501 

31. Evaluation of Diets Issued as Rations in the Theater 507 

32. Fifteenth Air Force, Monthly and Annual Rates for Important Causes of 

Noneffectiveness, 1944 510 

33. Fifteenth Air Force, Important Causes of Noneffectiveness by Months and 

Total for Year 1944 511 

34. Incidence of Infectious Hepatitis by Squadrons, 19 August-29 December 

1944 513 

35- Comparative Attack Rates in Personnel Over 30 Years of Age and Personnel 

Under 30 Years by Various Categories 514 

36. Disorders Due to Flying, Twelfth Air Force, November 1943-May 1944. . 515 

37. Total Casualties, Flying Personnel, Fifteenth Air Force, November 1943 

to May 1945 516 

38. Killed in Action, Flying Personnel, Fifteenth Air Force, November 1943 

to May 1945 517 

39. Wounded in Action, Flying Personnel, Fifteenth Air Force, November 

1943 to May 1945 517 

40. Ratio of Medical Department Personnel in 1944 to the Total Strength of 

the Eighth Air Force 576 

41. Gain and Losses in Medical Department Officer Personnel During 1944. . . 577 

42. Dental Officer: Personnel Status During 1944 579 

43. Distribution of Medical Department Personnel Within U. S. Strategic Air 

Forces in Europe 580 



[xviii] 



No. Pag* 

44. Flight Surgeons and Aviation Medical Examiners to Units of U. S. Stra- 

tegic Air Forces in Europe at Close of Period Covered by Report 582 

45. Distribution of Medical Department Personnel Within U. S. Strategic Air 

Forces in Europe 583 

46. Flight Surgeons and Aviation Medical Examiners Assigned to Units of 

U. S. Strategic Air Forces in Europe at Close of Period Covered by 
Report 585 

47. Distribution of Medical Department Personnel Within U. S. Strategic Air 

Forces in Europe 586 

48. Flight Surgeons and Aviation Medical Examiners Assigned to Units of 

U. S. Strategic Air Forces in Europe at Close of Period Covered by 
Report 588 

49. Air Evacuation : 609 

50. Patients Evacuated to United States 610 

51. Incidence of Body Injuries 645 

52. Incidence of High Altitude Cold Injury, Eighth Air Force 646 

53. Trend of Anoxia Accidents in the Eighth Air Force Heavy Bombardment 

October 1943-November 1944 655 

54- Permanent Removals from Flying 680 

55. Mean Strengths 680 

56. Admissions to Sick Report July 1942 to June 1945 681 

57. Admissions, All Causes, Diseases, and Nonbattle Injury, Air Forces in 

Western Europe, July 1942-June 1945 682 

58. Admissions, Common Respiratory Diseases, Air Forces in Western Europe, 

July 1942 Through June 1945 683 

59. Common Respiratory Diseases, July 1942-June 1945, Air Forces in Western 

Europe, Monthly Incidence 684 

60. Admissions, Pneumonia, Air Forces in Western Europe, July 1942 Through 

June 1945 685 

61. Admissions, Influenza, Air Forces in Western Europe, July 1942 Through 

June 1945 685 

62. Venereal Diseases by Type, White and Colored Personnel, Air Forces in 

Western Europe, July 1942 Through June 1945 686 

63. Admissions, Venereal Diseases, Air Forces in Western Europe, by Period, 

July 1942 Through June 1945 687 

64. Admissions, Gonorrhea, Syphilis, and Other Venereal Diseases, White 

Personnel, by Period 688 

65- Admissions, Gonorrhea, Syphilis, and Other Venereal Diseases, Colored 

Personnel, by Period 688 

66. Venereal Disease Rate by Commands, January Through June 1945 689 

67. Admissions, Diarrhea and Dysentery, Air Forces in Western Europe, July 

1942-June 1945 690 

68. Number of Cases of Malaria and Admission Rate, July 1942-June 1945, 

Western European Theater 691 

69. Admissions, Communicable Diseases, July 1943-June 1945, Air Forces in 

Western Europe 691 

[xix] 



No. Page 

70. Principal Causes of Death, Disease and Injury, Air Forces in Western 

Europe, July 1942 Through June 1945 692 

71. Cause of Wounds (1 November 1942-31 December 1943) 692 

72. Body Area of Wounds (1 November 1942-31 December 1943) 693 

73. Single and Multiple Area Wounds (1 November 1942-31 December 1943). - 693 

74. Types of Wounds (1 November 1942-31 December 1943) 694 

75. Wounds of the Extremities (1 November 1942-31 December 1943) 695 

76. Fatality Rate by Area of Body Struck (1 November 1942-31 December 1943) 695 

77. Incidence of Wounds by Crew Position (1 November 1942-31 December 

1943) - 696 

78. Mean Strength of Air Force Personnel, European Theater of Operations 

(January-June 1944) 698 

79. Air Force Battle Casualties, European Theater of Operations, Number, by 

Type of Aircraft, and Category (January-June 1944) 699 

80. Air Force Battle Casualties, European Theater of Operation, Rate per 

1,000 per Annum (January-Tune 1944) nnn 

04. iNumDer t^uiea ana Missing in Action 705 

85. ' 'Life Table" for Group of 1,000 Bombers Starting Sorties, Lost at Specified 

Rates in Successive Missions, and Completing Tour at End of 25 Missions 706 

86. Air Force Casualties in All Theaters (December 1941-August 1945) . . . 707 

87. Dental Classification, September 1944 to February 1945 791 

88. Morbidity Rate, First Air Commando Force, 1 February 1944-30 April 

1944 892 

89. Injuries 893 

90. Missing in Action 895 

91. Killed in Action 895 

92. First Air Commando Force 896 

93. Percentage of Combat and Noncombat Injuries, March 1943-June 1945- . . 920 

94. Medical Statistical Summary 942 

95. Direct Cause of Wounds in Forty-eight Wound Cases 945 

96. Wounds Classified as to Crew Position 946 

97. Severity of Wounds Tabulated as to Cause 947 

Charts 

No, Page 

1. War Department, Headquarters of the Army Air Forces, Washington — 

Organization of the Air Surgeon's Office, 25 April 1942 39 

2. Organizational chart for the Medical Service with the Army Air Forces, 

27 May 1942 fold-in after 38 



[xx] 



No. Pa Z* 

3. Flow of AAF personnel returned from overseas by air through ports of 

aerial embarkation 98 

4. Flow of AAF personnel returned from overseas 99 

5. Human factors in aircraft design 234 

6. Aero medical aspects of cabin pressumation 268 

7. Pressure cabin 269 

8. Radius of aircraft turn required to blackout average pilot at various true 

air speeds 269 

9. Speed a plane must make to pull 2 to 8 G's on a flight path of 700-yard 

radius 270 

10. "G" force resulting from varying radius of turn with constant speed 270 

11. Organizational chart, functional, Medical Section, Headquarters U. S. 

Strategic Air Forces in Europe 620 

12. Malaria — annual admission rate per 1,000. 909 

13. Malaria— noneffective rate per 1,000 910 

14. Venereal diseases — annual admission rate per 1,000 912 

15. Venereal diseases — noneffective rate per 1,000 913 

16. Diarrheal diseases — annual admission rate per 1,000 914 

17. Diarrheal diseases — noneffective rate per 1,000 915 

18. Common respiratory diseases — annual admission rate per 1,000 916 

19- Common respiratory diseases — noneffective rate per 1,000 917 

Illustrations 

Page 

General of the Army Henry H. Arnold ii 

Maj. Gen. David N. W. Grant (MC), The Air Surgeon vi 

Brig. Gen. Theodore C. Lyster 9 

Planning aviation medicine 1917, Theodore C. Lyster, W. H. Wilmer, I. H. 

Jones, and E. R. Lewis 10 

Staff of medical research laboratory — Mineola, New York 12 

First anniversary celebration of Convalescent Training Center 65 

Service commands — general hospitals — AAF regional station hospitals, AAF 

convalescent hospitals fold-in after 94 

Main building, School of Aviation Medicine, Mitchel Field, New York ..... 146 

The School of Aviation Medicine, Brooks Field, Texas, November 1929 147 

The School of Aviation Medicine, Randolph Field, Texas . 152 

One of the very first low-pressure chambers 199 

Low-pressure chamber — permanent type or fixed type 200 

Future flight surgeons work out in high-altitude chamber 201 

Aircrew indoctrination in low-pressure chamber for high-altitude flight 202 

Maj. Gen. Malcolm C. Grow (MC) 232 

Maj. Gen. Harry G. Armstrong (MC) 233 

The first building of the Aero Medical Laboratory 235 

A combat crewman wearing the Type A-10 Demand Oxygen Mask 254 



[xxi] 



Page 

A combat crewman wearing the Type A-14 Demand Oxygen Mask 254 

Simulating actual physical exertion of an airman in the sky. : 255 

Diagram of oxygen mask 256 

Lt. Col. Randolph Lovelace II (MC) 280 

Pressure suits 284 

Lt. Col. Melbourne W. Boynton (MC) 342 

Early air evacuation planes 353 

Interior of Douglas C-54 plane showing web strapping litter 362 

Four-motor bomber becomes mercy ship on return from bombing mission . . 363 

Evacuating the wounded at La Guardia Field, New York 364 

Interior of plane showing four tiers of litters 365 

Members of the first class of air evacuation nurses graduated from Training 

School at Bowman Field 379 

Evacuation of wounded in North Africa, near Tunisan field of operations .... 474 

Wounded on way to hospital 475 

The return of an Air Evacuation Unit whose plane was forced down 492 

Strecker visit to England in March 1944 569 

Nurses of an evacuation hospital unit of the Ninth Air Force 589 

General Patton with casualties waiting to be evacuated by air 602 

England. Personnel of a USAAF air evacuation hospital unit 603 

One of the " Grow Escadrille" 608 

Armored suit — familiarly called Flak Suit" — developed personally by Gen- 
eral Grow 619 

Helmet and face protector 625 

Life raft exhibit 626 

High-altitude frostbite fold-in after 626 

Stanbridge Earls, the first rest home in England for the Eighth Air Force 

officers 627 

Electrically-heated muff 629 

Heated bag used for transportation and care of wounded bomber crews 630 

Bed patient in traction using loom and wool to make a small rug 757 

Native stretcher bearers in New Guinea 767 

Natives carrying wounded along Peep Trail to be evacuated by transport plane, 

New Guinea 768 

Flight nurse secures a casualty of Okinawa into his stretcher on a huge trans- 
port plane 769 

Patients being loaded by the 804th Medical Air Evacuation Transport Squadron 770 
Patients of the 41st Infantry Division being evacuated from Dobadura, New 

Guinea 771 

Mindanao, Philippine Islands, 12 May 1945 772 



[xxii] 



INTRODUCTION 

Medical care for the fighting forces was complicated in World 
War II because of the scale and rapid pace of mobilization and deploy- 
ment of troops. In the Zone of Interior, young men and women were 
hurriedly drawn from civilian life and trained on a scale never en- 
visaged in the pre-war days. The Army including the Army Air Forces 
was to expand from 93,000 to an authorized strength of 7,700,000. 
For every member, the military medical staff had to carry out physical 
examinations, to screen and classify him according to his mental 
ability and aptitudes. The medical profession was then called upon 
to provide nearly 8 million individuals with routine sick care at base 
level together with all required specialty care. Doctors, in cooperation 
with the base commander and the engineers, were moreover responsible 
for preventing the sudden outbreak of epidemics caused by the crowd- 
ing of the new military population in makeshift facilities. Indeed, all 
medical resources were drawn upon to maintain fighting effectiveness, 
and newly inducted doctors found their professional skills suddenly 
mobilized to conserve the health of the forces. 

In the Army Air Forces alone personnel strength expanded by 1200 
percent. Its projected strength of 2,340,000 was reached over a 2-year 
period. By 1 January 1944 the figure stood at 2,385,000 officers and 
men. Insofar as medical care for such a force was concerned, the Army 
Air Forces was in a favorable position as compared with the remainder 
of the Army, for it was given first priority in the nation's manpower 
pool and could maintain the highest physical standards besides requir- 
ing the highest educational and technical standards. In terms of 
human resources, its fighting effectiveness should therefore be greater 
than that of the remainder of the Army. 

This was to prove true, although there were other factors which 
entered into the picture. Army Air Forces personnel, like all other 
military personnel, enjoyed the benefits of the three great wartime 
advances in military medicine: the use of penicillin, the administration 
of whole blood on the battlefield, and the evacuation by air of the sick 



[1] 



2 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

and wounded. In addition the Army Air Forces early violated tra- 
ditional practice by propounding two theories which were later ac- 
cepted by the medical profession and by the Army. The first encour- 
aged the patient to become ambulatory shortly after surgery rather 
than remain immobile for many days. The second encouraged the 
patient to speed his own return to normal after his wounds had healed 
bf turning his attention from his ailments to a program of education 
and physical rehabilitation. 

Yet another factor which made it possible for the AAF to maintain 
the highest rate of fighting effectiveness was in the area of management 
and was in itself a command problem. Because of the sudden and 
unprecedented expansion of the military forces, it had been necessary 
to revise Army management policies and procedures along the lines of 
c ' big business . * * At the same time it remained a basic military principle 
that the major force commander must control all resources, including 

highly trained pilots, bombardiers and gunners. Within the broad 
area of administration, therefore, it was necessary to maintain con- 
stant vigilance to make sure that personnel excused from duty because 
of illness were not actually absent because of cumbersome and obsolete 
procedures of hospital administration or unnecessarily distant travel 
from hospital to place of duty. Whatever the cause, each man-day 
lost lessened to that degree the total effectiveness of the fighting ma- 
chine. As the air offensive over Europe increased in intensity each 
man-day lost took on new significance. 

The Army Air Forces, however, had a primary medical mission 
which extended beyond that of maintaining combat effectiveness in 
peace and war. As does any combat force, it had also the responsi- 
bility of planning for war. This included the provision of proper 
organic medical support. Because the nature of the air combat 
mission itself had not yet been clearly defined and accepted among line 
officers, the nature of an effective medical service to support these forces 
could not yet be determined. Many officers viewed military aviation 
in terms of the dog-fights over France in World War I and had not yet 



INTRODUCTION 



3 



comprehended the newer lessons of aerial warfare in Europe. For 
that reason there were often clashes among ground and air officers and 
among combat and noncombat officers each of whom was trying in a 
troublous time to meet the imponderables of global war. As a result, 
it was too often an easy observation among the less knowledgeable 
that there were "personality clashes'' among responsible leaders. In 
that heat of the moment it was easy to forget the heavy burdens borne 
by those who ultimately had to make the command decision. 

At the TRIDENT Conference in May 1943 the Army Air Forces 
mobilization strength was fixed at 273 combat groups. This number 
comprised 5 very heavy bombardment (B-29's and 32's), 96 heavy 
bombardment (Flying Fortresses and Liberators), 26 medium bom- 
bardment, 8 light bombardment, 87 fighters, 27 troops carrier and 24 
reconnaissance groups. The dependence in combat upon human 
resources is apparent in the fact that every B-29 that flew over Japan 
required the efforts of 12 officers and 73 men in the combat area alone. 
The Air Staff, recognizing the need for harboring its human strength, 
was to be concerned throughout the war with the problem of how 
best to maintain fighting effectiveness in the combat areas. To meet 
that need, the rate of pilot production was about 75,000 per year not 
including glider, liaison, and observation pilots.* The First, Second, 
Third, and Fourth Continental Air Forces born of the old GHQ Air 
Force, tactical element of the prewar air arm, became the training 
ground for overseas air forces. These forces were eventually to go to 
every part of the globe, and in the combat areas not one trainee was 
expendable. To maintain combat effectiveness it was necessary that 
each individual be able to attend his duties, and it fell to the Surgeon 
to circumvent his being absent because of preventable sickness and to 
assure his return to duty within as few hours as possible. If his 
illness were prolonged, he must be replaced as quickly as possible. 
Only in this manner could the precarious balance between available 
skilled flying personnel and the combat requirements be maintained. 

During World War II, the professional aspects of military medicine 
were rendered yet more complex by the changing mode of war. As 
the techniques of waging surface warfare were modified by new 

*This was in contrast to the total of less than 7,000 pilots who had been training in the 19-year 
period prior to 1941. In the 20-year period prior to 1 July 1941, there had been less than 15,000 gradu- 
ates from Air Corps technical training schools to provide ground crews- but in the succeeding two year 
months over 625,000 men completed prescribed courses in specialties which had increased from 30 to 90 
specialties. 



4 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

weapons and increased mobility, the broad area of logistics became an 
increasingly central problem in the care of the sick and wounded and 
thus of the hospital system itself. The Letterman system of hospital- 
ization and evacuation devised for the Army of the Potomac and 
used thereafter for surface armies provided a system for the movement 
of the sick and wounded from the scene of battle to a medical center 
where they could receive proper care. Within the range of mobility 
provided by the infantry and cavalry this system had subsequently 
proved ideal for field armies. Whether it would prove so in World 
War II with the range of mobility increased through the use of tanks, 
motorized infantry, and airborne troops remained to be seen. 

The logistical element was important from both the professional 
and the command viewpoint. In the first instance, it could in part 
determine whether the surgery would be performed on the battlefield 
or the patient moved to the rear. Conversely, the airborne hospital 
might be carried to the patient in the field. From the command 
viewpoint, the logistical pattern of movement and timing to bring 
the patient and the facility together most expeditiously, would in part 
determine the arrangements for reception. 

In the Army Air Forces, the traditional professional problems of 
base and field routine medical care were applicable in that AAF 
personnel were subject to the same environmental hazards as other 
fighting personnel and were an integral part of the fighting machine 
as were all combat personnel. But in addition to these hazards, the 
flyer was faced also with physiological and emotional hazards to 
which he was subjected when he left his natural environment and 
became airborne. Such stresses were aggravated by his awareness of 
the nature of his combat mission over enemy territory. To a tradi- 
tionally-minded medical profession, military and civilian, however, 
the basic principles and problems of aviation medicine were not so 
clearly discernible as they were to those flight surgeons who had 
been closely associated with the Air Corps in peacetime years; and 
as research rendered the plane an increasingly potent weapon capable 
of traveling at hitherto untried altitudes and speed, even the prewar 
knowledge of the flight surgeon became obsolete. Thus, the human 
factor — man's physiological and emotional reaction to the stress of 
aerial combat — became a potentially weakening link in the air weapons 
system. Faced with this problem in the midst of a war, aviation 
medicine specialists were called upon as a matter of expediency to 



INTRODUCTION 5 

serve in capacities normally outside the scope of the medical service. 
The AAF was to carry out a vast aeromedical research program in 
the Zone of Interior. In the theaters, individual surgeons were to 
improve and develop techniques and equipment for immediate use on 
the battlefield. 

Of major significance in the field of military aviation medicine 
was the fact that the nature of the flyer's medical requirements was 
modified by the advances in the plane design and by the emergence 
of new aerial combat techniques. In the 1930's such figures as Wiley 
Post, Major General Grow and Maj. Gen. Harry G. Armstrong, 
USAF (MC), were interested in the physiological problems of low- 
altitude flight. Such terms as "aero embolism/' 4 'aero-otitis" and 
4 'bends' ' came into common usage in that era. But now in the war 
period the AAF was confronted with high altitude flight which 
brought the hazards of explosive decompression and pilot blackout. 
It was also faced with another problem, that of combat fatigue. This 
was a subtle poison which could lessen combat effectiveness by in- 
creasing the chances of pilot error in precision bombing and could 
ultimately render the individual useless as a member of the combat 
crew. It was to assume major proportion as the war progressed. 

Finally, a fact not fully appreciated in military circles was that, 
in contrast to the Army where actual fighting was carried on by sol- 
diers and relatively few officers, in the tactical aircrews the situation 
was completely reversed. For example, in fighter groups most of crew 
members were officers and in bomber groups many were officers. Thus, 
the combat efficiency of the individual Air Force officer was basic to 
the total effectiveness of the Air Force fighting machine. Moreover, 
in terms of National economy, the cost of training these highly special- 
ized officers, including the prohibitively expensive equipment needed, 
was many times greater for Air Force officers than for ground officers. 
This made the human element a matter of no little concern in the total 
National economy itself. 

Thus, the complicated problems of providing medical service for 
the first combat air force in our history emerged from many sources; 
they were military in scope, technical in nature. From the Royal Air 
Force the medical profession was to learn much; but ultimately the 
problem must be resolved by the Army Air Forces within the frame- 
work of its own potential. It is the purpose of this volume to describe 
how this was done. 



Chapter I 

ORIGINS OF AN AIR FORCE 
MEDICAL SERVICE 



It is difficult indeed to comprehend the progress made in aviation since 

the establishment on i August 1907 of the Aeronautical Division in the Office 

of the Chief Signal Officer of the Army. Composed of one captain, a corporal, 

and a first-class private, it was charged with "all matters pertaining to military 

ballooning, air machines, and all kindred subjects." 1 This initial step, a result 

of interest generated by the Aero Club of America, 2 was given legal sanction 

in 1914 when Congress charged the Aviation Section of the Signal Corps with 

the "operation of all military aircraft, including balloons and aeroplanes, [and] 

all appliances pertaining to such craft. . . /' 3 In the National Defense Act of 

1916 the Aviation Section was recognized as a part of the Signal Corps. 4 
« 

Evolution of a Physical Examination for Flyers 

It was soon apparent that the personnel of this new aviation organization 
would have to meet certain physical standards. As early as February 1912, 
The Surgeon General, at the direction of the Secretary of War, prepared a 
special preliminary physical examination for candidates who were to receive 
instruction in the Aviation School of the Signal Corps. 5 This first examination, 
approved by The Chief Signal Officer, relied heavily upon the Army examination 
for recruits, with added emphasis upon the eyes, the ears, and the heart. In his 
Principles and Practice of Aviation Medicine, the standard reference in the field, 
Armstrong notes that while these special instructions for physical examination 
of candidates as issued by the United States War Department in 1912 "are of 
considerable historical interest . . . unfortunately the author is unknown." 6 
The instructions stipulated that: 7 

All candidates for aviation duty shall be subjected to a rigorous physical examination 
to determine their fitness for such duty. 



[6] 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



7 



The visual acuity without glasses shall be normal. Any error of refraction requiring 
correction by glasses or any other cause diminishing acuity of vision below normal will be 
a cause for rejection. The candidate's ability to estimate distances should be tested. Color 
blindness for red, green, or violet is a cause for rejection. 

The acuity of hearing should be carefully tested and the ears carefully examined with 
the aid of the speculum and mirror. Any diminution of the acuity of hearing below normal 
will be a cause for rejection. Any disease whatever of the middle ear, either acute or 
chronic or any sclerosed condition of the ear drum resulting from a former acute condition 
will be a cause for rejection. Any disease of the internal ear or of the auditory nerve will 
be a cause for rejection. 

The following tests for equilibrium to detect otherwise obscure diseased conditions 
of the internal ear should be made: 

1. Have the candidate stand with knees, heels and toes touching. 

2. Have the candidate walk forward, backward, and in a circle. 

3. Have the candidate hop around the room. 

All these tests should be made with the eyes open, and then closed; on both feet, and 
then on one foot; hopping forward and backward, the candidate trying to hop or walk 
in a straight line. Any deviation to the right or left from a straight line or from the arc of 
the circle should be noted. Any persistent deviation, either to the right or left, is evidence 
of a diseased condition of the internal ear, and nystagmus is also frequently associated with 
such condition. These symptoms, therefore, should be regarded as cause for rejection. 

The organs of respiration and the circulatory system should be carefully examined. 
Any diseased condition of the circulatory system, either of the heart or arterial system, is a 
cause for rejection. Any disease of the nervous system is a cause for rejection. 

The precision of the movements of the limbs should be especially carefully tested, 
following the order outline in par. 17, G. O. 60, W. D., 1909. 

Any candidate whose history may show that he is afflicted with chronic digestive dis- 
turbances, chronic constipation, or indigestion, or intestinal disorders tending to produce 
dizziness, headache, or to impair his vision, should be rejected. 

Lt. F. J. Gerstner, 10th Cavalry, and Lt. F. T. Armstrong, Coast Artillery 
Corps of the United States Army, were the first candidates to take and pass 
this Army examination. They were subsequently transferred to the Aviation 
Section of the Signal Corps. 

In July 1914 Col. Samuel Reber, head of the Aviation Section of the Signal 
Corps, requested that The Surgeon General prepare a more satisfactory physical 
examination for young officers who were shortly to transfer to his office. Medical 
personnel assigned to the problem turned for guidance to the standards required 
in foreign armies, especially in connection with the eyes and ears. When no 
information was secured from this source, an examination was prepared which 
relied upon standard physiology texts and incorporated existing requirements 
for vision and hearing as defined in the regulations of the Military and Naval 
Services. 8 The results of this examination brought The Chief Signal Officer 
back to The Surgeon General within a few weeks with the request that 



8 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



standards be lowered, because in the interim no one had passed the examina- 
tion. 9 This was done. 

Two years later, in 1916, a board consisting of one Medical Corps officer 
and two Signal Corps officers was appointed "for the purpose of examining 
and determining the fitness of persons who make applications for commissions 
in the Aviation Section of the Signal Officers' Reserve Corps." 10 Heading this 
group was Lt. Col. Theodore Charles Lyster, the acknowledged Father of 
Aviation Medicine in America, assisted by Maj. William H. Wilmer and Maj. 
I. H. Jones. 11 Later Capt. Ralph H. Goldthwaite was also named assistant to 
Lt. Colonel Lyster when all matters pertaining to the physical examination of 
applicants for duty with the Aviation Section, Signal Officers' Reserve Corps, 
were placed under the colonel's jurisdiction. 12 By May 1917 the Lyster Board 
had established new standards 13 out of which the basic "AGO 609," used 
throughout the war period, was developed. 14 

An important problem facing the Aviation Section during World War I 
was that of recruiting flying personnel for training. Soon after the completion 
of AGO Form 609, Major Jones was informed by Maj. Gen. William C. Gorgas, 
The Surgeon General, that he was to take over the work of recruiting for 
aviation. 15 He began a tour of the principal cities of the country in an effort 
to set up the necessary machinery for examining aviation applicants. The usual 
procedure was to explain the program to the doctors of a particular city and 
commission an outstanding member of their group who was placed in charge of 
the local program. 16 Examining boards of three members each were established, 
with the senior officer serving as president, and the other two members repre- 
senting the Air Service and the medical profession respectively. Since it was 
impossible for one man to have the necessary knowledge of all medical fields 
required in the physical examination, a physical examining unit was established. 
The examining board acted only after receiving a complete report from the 
physical examining unit. In the course of the recruiting program 67 examining 
boards and a like number of examining units were established. 17 

A total of 38,777 men were examined for pilots by 2 June 1918, with 20,773, 
or nearly 54 percent, meeting the physical standards set by the Medical Depart- 
ment, 18 Another 10,000 applicants were examined for non-flying commissions 
by the examining units during the period from 14 July 1917 to 2 June 1918, 
of whom 6,470 were accepted. 19 There were 11,438 flying officers commissioned 
during the war. 20 According to Armstrong, a tabulation of results of the 
physical examination of all cadet flyer applicants, 70.7 percent were qualified 
and 29.3 percent were rejected. Of those rejected, 50 percent failed to meet 
eye requirements. 21 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 




Center of bottom row is Brig. Gen. Theodore C. Lyster, Chief Surgeon, 
Aviation Section, Signal Corps. 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



11 



It is significant to note the ratio of flying hours to fatalities, considering 
the type of planes in use. During the fiscal year of 1918, 407,999 hours were 
flown by Army aviators in the United States with 152 fatalities, which was a 
ratio of 2,684 flying hours for each death. 22 

Establishment of Medical Research Laboratory 

Armstrong notes that the physical standards established for pilots by 
Lyster and his co-workers were "based almost entirely on empirical grounds" 
and, in the opinion of Lyster, required further study. At the same time the 
"appalling death rate among flying cadets at the training centers in the United 
States and among the Allies in France indicated the need for an extensive 
research program." 23 The British found, after studying fatalities of their 
aviators for the first year of the war, that 9 percent of such casualties were due 
to individual deficiencies. A further breakdown showed that 60 percent of 
the fatalities were chargeable to physical defects. The results of this analysis 
led the British to provide a service for the "Care of the Flier." Fatalities due 
to physical defects were reduced from 60 percent to 20 percent for the second 
year and to 12 percent the third year. 24 

When, in September 1917, Colonel Lyster was designated the first Chief 
Surgeon, Aviation Section, Signal Corps, United States Army, one of his first 
acts was to recommend that a research board be established "with discretionary 
powers to investigate all conditions affecting the physical efficiency of pilots, to 
carry out experiments and tests at different flying schools, to provide suitable 
apparatus for the supply of oxygen," and finally "to act as a standing organiza- 
tion for instruction in the physiological requirements of aviators." 25 Before it 
received formal status this board was to meet at least three times — 27 September 
1917, 2 October 1917, and 12 October 1917. On the second date the group met 
at Hazelhurst Field, Mineola, Long Island, to inspect flying conditions at the 
field and to consider the feasibility of locating a laboratory there. It appears 
that a tentative plan of organization for the proposed medical research labora- 
tory was agreed upon at that time with departments and personnel as follows : 26 
Physiology, Maj. Knight Dunlap; Otology, Maj. E. R. Lewis; and Ophthalmol- 
ogy, Maj. W. H. Wilrqer. Later the Department of Neurology and Psychology 
was added with Maj. Stuart Paton as the head. Later plans called for Capt. 
Conrad Berens, Jr. to succeed Maj. W. H. Wilmer as head of the Department 
of Ophthalmology, when the latter was appointed Officer-in-Charge of the 
Laboratory at Mineola. 27 

The board was officially established on 18 October 1917 by War Department 
Special Order No. 113, which directed Maj. John B. Watson, Major Lewis, Major 

262297°— 55 3 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



13 



Wilmer, and Maj. Edward E. Seibert to report to the Chief Surgeon for duty 
as members of a medical research board. 28 Dr. Yandell Henderson, the civilian 
member of the board, was appointed chairman. 29 

During the next few weeks while waiting for the completion of the physical 
plant at Mineola, the board met at various places in Washington. By 19 January 
1918 the original plant of the Research Laboratory was sufficiently near comple- 
tion to permit certain members of the board to report for duty, and the roster 
read as follows: 80 

Director of the Laboratory Col. W. H. Wilmer. 

Cardiovascular Department Maj. J. R. Whitney. 

Neuropsychiatry Department Maj. Stewart Paton, 

Ophthalmology Department Capt. Conrad Berens. 

Otology Department Lt. Col. Eugene R. Lewis. 

Physiology Department Maj. Edward C. Schneider. 

Psychology Department Maj. Knight Dunlap. 

Under the direction of Colonel Wilmer, the first aviation medical laboratory 
at Mineola developed an extensive research program. Among the important 
projects undertaken there was an altitude classification test for pilots by use of 
rebreather apparatus, an improved model based on earlier ones used by Hender- 
son at Yale. Other methods used were the nitrogen dilution method and the 
low-pressure chambers which were capable of simulating an altitude of 35,000 
feet. Another important study made was the Schneider Cardiovascular Index 
rating which was used as part of the physical examination for flying. Yet 
another project was the personality study prepared by psychologists, neurolo- 
gists and psychiatrists at the laboratory, who had concluded that the mental 
and nervous state of the candidate was of great importance. 

In 1921 the research laboratory was destroyed by fire, and there followed 
a decade when little attention was given to aviation medicine research. This 
pioneer effort had left its impact, however. In the words of Armstrong: 31 

The Air Service Medical Research Laboratory was the first of its kind to be established 
and its contributions to aviation medicine are incalculable in relation to the saving of lives 
and equipment. Of equal importance is the fact that this institution was the medium 
through which aviation medicine in all its ramifications was placed on a sound scientific 
basis in America. 

Medical Support of Combat Mission in World War I 

The appointment of Lt. Col. Theodore C. Lyster as Chief Surgeon, Avia- 
tion Section, Signal Corps, on 6 September 1917, 32 was an important landmark 
in the early history of the Air Force Medical Service. Although Lyster had 



14 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



been in charge of the physical examination program of the Aviation Section 
since May 1917, a separate office was not provided for him until July 1917. On 
that date a room connected with the attending surgeon's office at 1106 Con- 
necticut Avenue, Washington, D. C, was made available. The first office force 
consisted of an enlisted man and a stenographer. (See: Medical Department 
of the United States Army in the World War, Vol. I, p. 488.) The order 
accomplishing his appointment was apparently the source of authority for the 
establishment of a separate medical service for the Aviation Section. Eleven 
days later, on 17 September 1917, an Air Division of the Signal Corps was 
organized into six sections, of which one was the "Medical Department.'' The 
authorizing directive defined the duties of the chief surgeon of the new medical 
department as being synonymous with those outlined for department surgeons 
and chief surgeons of field armies. 33 

There is evidence that Colonel Lyster and The Surgeon General agreed 
as the basic concept of this aviation medicine service that the chief surgeon 
should have a free hand in directing the affairs of the newly established 
Medical Department, functioning immediately under the Commanding Gen- 
eral, Air Division. This position was made clear by Colonel Lyster in a letter, 
dated 1 October 1917 to the Commanding General, in which he stressed that 
"good administration" required all medical matters affecting any unit of the 
Aviation Section to be the province of the chief surgeon. 34 For purposes of 
medical administration, he recommended that "both Langley Field [Va.] 
and the Construction Division [sic] be placed under the jurisdiction of the 
Aviation Section." He also recommended that the Medical Department, in 
the name of the Commanding General, be permitted to handle all orders and 
correspondence of medical importance; and that, after squadrons were supplied 
with medical personnel during the period of mobilization, requests for the 
movement of these squadrons include attached medical personnel without 
additional orders from the Medical Department. 35 In other words, medical 
units should be an organic part of the squadron and not require additional 
authorization for overseas movement. Summarizing his position, Colonel 
Lyster reasoned in this manner: 36 

It is believed this method of administering the affairs of the Medical Department in its 
relation to the various divisions of the Aviation Section, Signal Corps, will greatly add to its 
efficiency and will work in harmony with the present organization of The Surgeon 
General's Office, establishing the same relations existing between The Surgeon General 
and the chief surgeon of a field army. 

The first indorsement of this letter from the Administrative Division over the 
signature of Col. H. H. Arnold recommended approval of all the suggestions 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



15 



made, adding that the scope of the Medical Department's activities covered "any 
other Division of the Signal Corps with which it may come in contact." 37 

The Medical Section of the Air Division was established on 9 January 1918, 
to "have charge of all medical personnel of the Aviation Section of the Signal 
Corps and all medical equipment and supplies furnished for the use of the 
Aviation Section." 38 Within a short time the Chief Surgeon, Colonel Lyster, 
had his organization completed and functioning. 39 It included 5 Medical Corps 
officers and 3 Sanitary Corps officers. 40 

Within a matter of weeks, however, the War Department was considering 
transfer of the organization from the Signal Corps, of which it was an integral 
part, to the Army Medical Department. In a communication to The Inspector 
General, dated 30 April 1918, Colonel Lyster urged that the Service be separate 
from the control of The Surgeon General, and marshalled a number of potent 
arguments in support of his position. Only a separate medical service, he 
argued, could provide this swiftly growing department with the specialized 
medical care it needed and with sufficient speed. Medical problems of flying 
were in their infancy and their solution could come only by "saturation in and 
immediate contiguity" with them. Moreover, in the interests of good admin- 
istration, these air medical services needed to be centralized. This step within 
the Aviation Section would produce, for example, more effective hospital con- 
struction at the flying schools than when accomplished under The Surgeon 
General's construction program. Finally, the Chief Surgeon urged that the 
medical service be judged wholly on its merits and not transferred to The 
Surgeon General "on the specious ground of personnel economy." 41 Despite 
his ple^, however, The Adjutant General had by 9 May issued orders relieving 
him from duty with the Signal Corps and placing the entire medical program 
of the Aviation Section under the jurisdiction of The Surgeon General. 42 The 
order relieving Colonel Lyster from duty as Chief Surgeon with the Aviation 
Section of the Signal Corps was dated two days later, 11 May 1918, 43 and he 
was subsequently ordered to duty in The Surgeon General's office to be in charge 
of aviation matters. 44 

Whether by 14 May Colonel Lyster had actually received the orders referred 
to above is not known, but he had received notice that the Medical Division of 
the Signal Corps was to be transferred to The Surgeon General. This informa- 
tion prompted him on that date to carry his plea to the Commanding General, 
Air Service Division, stressing the advantages of the separate medical organiza- 
tion and strongly urging that it remain under Air Service Division control. 
Colonel Lyster reminded the Commanding General that both The Surgeon Gen- 



16 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

eral and The Chief Signal Officer were in complete agreement with this concept, 
and both agreed that the recent experience of the Medical Section under the juris- 
diction of the Signal Corps had demonstrated the superior efficiency of such 
control to that of The Surgeon General. "The consolidation of this service 
[Colonel Lyster wrote], trained to speed up in its activities, with the much 
larger less mobile organization of The Surgeon General's office, is sure to result 
in the slowing up of our work." He continued that "no matter how efficient 
the machinery of this larger organization, it is bound to be; slower and the 
facility of quick, independent service would be lost to us." 45 Further support 
for Colonel Lyster's viewpoint came from Maj. Gen. W. L. Kenly, who within 
a few days was to be named Director of Military Aeronautics, and who stated 
that the medical work had been entirely satisfactory. He recommended that 
"this organization be permitted to perform its duties in the same manner as it 
has in the past." 46 It is clearly obvious, in view of the foregoing statements, 
that the impetus for the change in the medical organization came from the War 
Department level and not from The Chief Signal Officer, the future Director 
of Military Aeronautics, or The Surgeon General. Despite this reasoning and 
support, however, the n May transfer was to remain in effect for nearly a year. 

While to Colonel Lyster the transfer may have seemed to be of singular 
importance, it was nevertheless but a small part of the military organization 
which was evolving to meet the primary strain of the war emergency and the 
possible potential of air power. In the spring of 1918 Congress passed a law 
entitled "An Act Authorizing the President to coordinate or consolidate execu- 
tive bureaus, agencies, and offices, and for other purposes, in the interest of 
economy and more efficient concentration of the Government." 47 The Act 
expressly authorized the President to establish an executive agency to control 
airplane production, 48 and it served as a basis for President Wilson's Executive 
Order which provided both for a Director of Military Aeronautics to have 
charge of the Aviation Section of the Signal Corps and for the establishment 
of the Bureau of Aircraft Production. 49 The President directed on 22 May 1918, 
eleven days after the transfer of the medical service to The Surgeon General, that 
an Air Service be organized to include the existing Aviation Section of the 
Signal Corps, and to consist of a Bureau of Aircraft Production and a Division 
of Military Aeronautics. 50 These two agencies having equal authority in their 
respective fields, neither the Department of Military Aeronautics nor the Bureau 
of Aircraft Production could be held responsible for the production of an accept- 
able plane to be used in combat; and while an agreement was ultimately 
reached between the two agencies whereby plans must be mutually agreed upon 
before production, 51 the basic difficulty was not obviated until the entire Air 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



17 



Service was consolidated under a Director of Air Service on 29 January 1919. 52 
On that date the Director of Military Aeronautics issued an office memorandum 
establishing the Division of Military Aeronautics, with an attached chart of the 
organization and an outline of the duties of each section. 53 Three days later a 
memorandum instructed all sections that the office would henceforth be known 
as The Department of Military Aeronautics. 54 

In this new organization a "Medical Division (or Section)" was estab- 
lished, charged with handling "all matters pertaining to the administration of 
personnel, equipment, supplies, and all other matters affecting the Medical 
Department which relate to the development, maintenance, organization and 
operation of aeronautical personnel." An accompanying organizational chart 
showed Medical Department units as follows: Hospitals, Medical Research, 
Medical Personnel, Care of Flyers, and Report and Returns. 55 With the excep- 
tion of the appointment of Maj. F. J. Martel as Chief Physical Director under 
Care of the Flyer Unit, the personnel of the medical organization remained the 
same as it had been under the Signal Corps. 56 The new organization was 
referred to as the "Air Service Division of the Office of The Surgeon General, 
attached to the Division of Military Aeronautics," 57 and was designated as 
such until 14 March 1919 when responsibility was vested in the Chief Surgeon 
of the Air Service. 58 

Meanwhile, by the fall of 1917 the initial problem of recruiting personnel 
had been solved, the Medical Research Laboratory established, equipment and 
medical specialists secured, and the first Chief Surgeon officially designated. 69 
It was an opportune time to send a medical mission to the front. 60 In October, 
four medical officers accordingly proceeded to France, where they reported to 
the Commander-in-Chief, American Expeditionary Forces, for duty. 61 They 
were Colonel Lyster, the new Chief Surgeon, and Majors I. H. Jones, Harris P. 
Mosher, and George E. de Schweinitz. 

While there, Colonel Lyster was appointed Chief Surgeon, Air Service, 
A. E. F., by the Chief of Air Service. This appointment was based on para- 
graph 1 of General Orders No. 80, Headquarters, A. E. F., which provided that: 
"The Chief of the Air Service will exercise general supervision over all elements 
of the Air Service and personnel assigned thereto, and will control directly 
all Air Service units and other personnel not assigned to tactical commands 
or to the L. [Line] of C. [Communication]". 62 Unfortunately, Colonel Lyster's 
appointment became a source of immediate jurisdictional difficulty. The Chief 
Surgeon from Headquarters Line of Communication, A. E. F., wrote immedi- 
ately to his Commanding General for an interpretation of General Order No. 80 



18 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



in connection with medical personnel serving with units of the Air Service 
located on the Line of Communications, 63 and advised him that Colonel Lyster 
intended to obtain exclusive control of all medical personnel on duty with the 
Air Service behind the front. 64 This correspondence which ultimately reached 
the Commander-in-Chief, A. E. F., noted that "this medical officer, Colonel 
Lyster, presents a scheme for my consideration which contemplates an organi- 
zation having a Chief Surgeon, with an office force, Surgeon, Zone of Advance, 
Surgeons, Line of Communications, Surgeons for squadrons, etc. — All of the 
Air Service." 65 In reply, A. E. F. Headquarters stated that orders issued at 
the time Colonel Lyster was assigned to the Office of the Chief of Air Service 
clearly defined his status and that "orders dated 20 December 1917, issued from 
the C. A. S. office are in contravention of these instructions and will be revoked 
by the C. A. S. Colonel Lyster is not 'Chief Surgeon,' Air Service, A. E. F." 60 
It was further explained that the purpose of the assignment of Colonel Lyster 
and certain other medical officers to the Air Service had been "for the sole pur- 
pose of providing technical advisers to the Air Service in medical questions 
incident to flying." 67 Immediately upon receipt of this correspondence, the Air 
Service issued an order revoking the original order which designated Colonel 
Lyster as the Chief Surgeon, Air Service, A. E. F. 08 Thus, the office of the 
Chief Surgeon, Air Service, A. E. F., survived less than 1 month. 

The concept of the flight surgeon apparently crystallized in the minds of 
Colonel Lyster and Major Jones while visiting the aviation groups at the front, 69 
although earlier thought obviously had been given to the matter. While there, 
Major Jones explained to the British his ideas for a projected program for the 
care of the flyer. 70 

After the mission returned, a program of selection and training of flight 
surgeons 71 was instituted at the Mineola Laboratory. By June 1918 it was 
"functioning as a well-organized school for the training of flight surgeons, 
and for instructing physical trainers for their work at the various flying 
schools." 72 Candidates for training were selected from medical examiners 
in various sections of the country and sent there to study aviation medicine. 
Plans called for a flight surgeon to be stationed at all the aviation training 
schools in the country, and for Major Jones to travel from post to post, explain- 
ing the purpose of the program to the commanding officers, "in the hope that 
the new flight surgeons would be kindly received." 73 

A memorandum issued on 3 June 1918 74 described the personnel to be 
included under the Care of the Flyer Unit and defined the relationship of the 
flight surgeon to the post surgeon and commanding officer. The flight surgeon 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



19 



was adviser to the commanding officer and flight commander "in all questions 
of fitness of aviators or aviation students to fly." Although the flight surgeon 
was under the jurisdiction of the post surgeon, an effort was made to insure his 
freedom of action within his sphere of interest, and the 3 June memorandum 
stated that: "Post Surgeons are hereby advised that in all matters relating to 
care of flyer, the Flight Surgeon should be given free hand and his advice will 
control. . . " 75 

In connection with overseas duty, while the first officers assigned to the 
aviation squadrons had not been specially trained in aviation medicine, it 
was contemplated that the new flight surgeon program would provide specialists 
at the front as needed. In August 1918, 34 officers and enlisted men were 
sent overseas in response to a cabled request from General J. J. Pershing, the 
first group to have completed the special training courses offered at Mineola. 76 
The officer personnel of this group constituted the Medical Research Board 
No. 1, Branch Units No. 1 and No. 2, Medical Aviation Unit No. 1 and the 
Ophthalmo-Otological Unit. The Medical Aviation Unit No. 1 was assigned 
to the British for aid in the care of the flyer. The Ophthalmo-Otological group 
was stationed at Vichy, France, and the Medical Research Board and laboratory 
units were located at the Third Aviation Instruction Center, France. The group 
arrived at Issoudun on 2 September 1918 77 with 14 tons of equipment, enough 
to supply 10 flight surgeons and equip the laboratories. Col. W. H. Wilmer 
was placed in charge of the Medical Research Laboratories, Air Service, A. E. F., 
while Col. Thomas R. Boggs, who had made special studies of the medical 
problems of the Allies, was designated Medical Consultant, Air Service, A. E. F. 78 
When a request came from the main field for a flight surgeon, Maj. Robert R. 
Hampton received the appointment and, on 17 September 1918, became the 
first practicing flight surgeon in the A. E. F. Later several assistants were sent 
to help him. 

Armstrong in his Principles and Practices of Aviation Medicine writes: 79 

In the meanwhile a number of other events of historical interest were occurring. These 
include the issuing of flight orders to Colonel Ralph Green in 19 16, the first medical officer 
ordered to flying duty; the death of Major William R. Ream on 24 August, the first flight 
surgeon to be killed in an aircraft accident; and the reporting for duty of Captain Robert J. 
Hunter on 8 May 191 8 as the first trained flight surgeon in the United States ordered 
to such duty. 

While Captain Hunter was the first surgeon to graduate from Hazelhurst Field 
and to be officially designated as such by orders, 80 Gen. H. H. Arnold, Com- 



20 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

manding General, Army Air Forces, in 1944 called attention to the work of 
"a Lt. John Kelley," whom he knew from 191 1 to 1913, and regarded as a "first- 
class flight surgeon." General Arnold was, therefore, of the opinion that the 
honor should properly belong to Lieutenant Kelley. 81 

During the postwar period the School of Flight Surgeons continued for 
several years at Mineola despite the fire in 1921. It was moved to Brooks Field 
in 1926 and, in 1931, to the recently completed Randolph Air Base, Texas. 

The Interim Years 

When, on 14 March 1919, The Surgeon General abolished the Air Service 
Division of his office, and delegated its functions once again to the Chief 
Surgeon, Air Service, 82 it was, according to Colonel Lyster, a "belated acknowl- 
edgment" by the War Department of the validity of his arguments for a 
separate aviation medical department. 83 The newly established Medical Divi- 
sion was placed under the "Administrative Group" of the Air Service and 
functioned in this status until the reorganization of November 1921, when it 
was designated the Medical Section, "charged with all matters pertaining to 
sanitation and hospitals at stations under the direct control of the Chief of Air 
Service," for "directing activities of the Medical Research Laboratory and School 
for Flight Surgeons" and for "exercising supervision over the technical work 
of flight surgeons and rebreather units." 84 

Once the demobilization problems of World War I were resolved, the 
office of the Chief of the Medical Division (later "Section") was largely con- 
cerned with the routine processing of physical examinations for flyers, the 
number of which increased each year. The personnel of the office included 
two Medical Corps officers and one Medical Administrative Corps officer, the 
latter being relieved in 1923. 85 The medical organization remained a "section," 
occupying various places in the organization chart of the Air Service, and later 
the Air Corps, until 1 July 1929, when it was raised to division level under the 
Chief of the Air Corps, without any change in duties. 86 Divided into four 
sections — Personnel, Physical Examination, Aviation Medicine, and Statistics — 
the organizational structure remained in effect until 1936, at which time the 
Medical Division was again reduced to the level of a section and placed under 
the Personnel Division, Office, Chief of the Air Corps. 87 This arrangement 
lasted until 1 April 1939, when the Medical Section under Lt. Col. Malcolm C. 
Grow, was redesignated the Medical Division and assigned to the Training 
Group, Office, Chief of the Air Corps. 88 The internal organization remained 
the same. 89 In a reorganization of the Office of the Chief of the Air Corps, 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



21 



12 September 1939, the Medical Division was removed from the jurisdiction of 
the Training Group and made a major subdivision of the Office of the Chief 
of the Air Corps. 90 On 30 October 1941, Col. David N. W. Grant was desig- 
nated "The Air Surgeon/' 91 in addition to his duties as Chief of the Medical Di- 
vision, and on 16 February 1942, the Medical Division of the Office of the Chief 
of the Air Corps was transferred to the Office of the Air Surgeon, thus complet- 
ing the organization of the Air Surgeon's Office 92 in the early days of World 
War II. These developments are discussed in some detail below in their rela- 
tion to the development and expansion of the Air Corps. 

Throughout the interim period between the wars, leaders of the Air Service 
were thinking in terms of a separate air force, and plans naturally included an 
air force medical service. The organizational trends and developments of the 
Air Service (later Air Corps) pointing toward a separate air force were usually 
reflected in the Medical Department, and staff studies included a medical 
supporting plan. For example, the Chief of the Medical Section received a 
memorandum from the Executive dated 24 December 1924 (which included a 
copy of a letter from Maj. Gen. Mason M. Patrick, Chief of Air Service, to The 
Adjutant General), in which he was asked for comments and recommendations. 
His attention was specifically called to paragraph 4 of the General's letter which 
read: 93 

I am convinced that the ultimate solution of the air defense problem of this country is a 
united air force, that is the placing of all of the component air units, and possibly all 
aeronautical development under one responsible and directing head. Until the time when 
such a radical reorganization can be effected certain preliminary steps may well be taken, 
all with the ultimate end in view. 

The Chief of the Medical Section, Lt. Col. W. R. Davis, replied that if an 
air corps were authorized, it should also include a medical service. He 
reasoned : 94 

The selection, classification and care of the flier present problems that are different from 
those of any branch of the service. They cannot possibly be solved except by those of 
special training. The authorization of Flight Surgeons has proved a boon to the present 
Air Service. It has been recognized by the Royal Air Force, by the Italian Air Force, and 
although the French have not a separate Air Force they have a school of instruction for 
medical officers similar to our School of Aviation Medicine. Flight Surgeons become 
increasingly valuable as their experience increases. Under the present system a Flight 
Surgeon has no assurance that his work will continue in the Air Service. 

It was recommended accordingly that there be: (1) a recruiting program that 
might be facilitated by "increased pay for flying, and probably more rapid pro- 
motion . . ."; (2) the eventual establishment of general hospitals; (3) a major 



22 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

general for the surgeon general and two brigadier generals for his assistants; 
(4) a medical administrative section; and (5) a "specialists section" consisting 
of not more than 10 scientists. 95 This program was obviously far enough 
advanced so that its fulfillment could not have been anticipated in the immediate 
future. 

During the next year the trend was toward the establishment of an Air 
Corps and all air-minded officers were naturally concerned. The attitude of 
the flight surgeon in the field was reflected by flight surgeon I. B. March in 
a letter addressed to the Commanding Officer, Mitchel Field, in October 1925. 
Touching on topics which ranged from air evacuation to the basic attitude of 
medical officers, he stated: 96 

The present system of sending seriously injured and sick aviators over miles of poorly 
paved roads in a G. M. C. truck with an ambulance top on it, needs no further criticism 
than that the statement is a fact, a condition which exists at the present time. We need 
better hospital facilities, a nurse corps of our own, in fact all the material and personnel 
in each corps area to take care of our own sick and injured at their home station. If the 
Air Service is to expand, the Aviation Medical Service should expand with its own service 
and not be dependent upon a distant Corps Area or other hospital for this service. Air 
Service personnel should remain under the direct care of Medical Officers who are trained 
with and understand the conditions of the Air Service and are in direct sympathy with 
the flyers and will not be so likely to send a pilot back to duty until he is fit to fly. 

He further recommended: (1) a corps of flight surgeons directly under 
command of the Chief of Air Service; (2) leaves of one month each year for 
all officers and men to be given during the time of the year when they could 
be taken with benefit; (3) selection of medical personnel to be made by the 
Chief of Air Service upon recommendation of the Chief of the Medical Section ; 
(4) that all medical officers at flying fields be flight surgeons; (5) that waivers 
be requested directly from the Chief of Air Service upon recommendation of 
the station flight surgeon and the Chief of the Medical Section ; and (6) that 
medical care of civilian aviators be taken over by the government and placed 
on the same basis as the medical care of military aviators. Even though academic 
in nature, plans and recommendations of this type helped clarify the nature of 
a potential medical service for a separate air organization. 

In November 1925, preceding the Air Corps Act of July 1926, The Surgeon 
General was asked to express his views on the needs of the Medical Department 
of the future. His final report included recommendations for the Medical Sec- 
tion of the Air Service. 97 The portion of the report, prepared by Colonel 
Davis, Chief of the Medical Service, Air Service suggested that: (1) the per- 
centage of flight surgeons for duty with the Air Service be greater than the 
medical officer strength allotted to other combat branches, because their duties 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



23 



were more arduous and more time was required for complying with existing 
regulations; (2) the number of flight surgeons be increased in proportion to the 
expansion of the National Guard and Reserve of the Air Service; (3) only 
members of the Medical Corps be selected for aviation medicine who demon- 
strated the necessary qualifications and afterward be permitted "to continue in 
this specialty"; (4) there be a prerequisite of the completion of the course of 
instruction at the Army Medical School and five years of field service with other 
combat units be required for entrance into the School of Aviation Medicine; (5) 
certain flight surgeons be exempted from duty with troops in order to be instruc- 
tors at the School of Aviation Medicine; (6) airplane ambulances be considered 
as the "most rapid, comfortable and safe method of transportation of sick and 
injured, especially in time of war"; (7) a flight surgeon be detailed as instructor 
at the Field Service School at Carlisle, Pa. 98 

Maj. L. H. Bauer recently of the Medical Section made suggestions on vari- 
ous aspects of the medical service for the Air Service," namely that those medical 
officers at air service stations be flight surgeons and that the ratio of flight 
surgeons to cadets at primary training schools be 1 to 35. A comprehensive 
outline policy of selection and training of flight surgeons was proposed as 
follows: 

1. Select no officer for air service duty below the rank of captain. 

2. Send the officer selected to the School of Aviation Medicine for a term of four 
months and then assign him to Brooks Field for six months for the practical application to 
flight surgeon work. 

3. Follow this tour of duty at Brooks Field with a four-year assignment to the Air 
Service. 

4. If the officer has been successful in his assignments so far, he will then be sent to a 
general hospital for a year's intensive training in clinical work, and after completion of 
this work he will be redetailed to the Air Service for another period of four years. 

5. After satisfactory completion of the last four-year assignment, the officer would be 
sent to Carlisle for the advanced course and in turn to the School of Aviation Medicine 
for an advanced course there. After the satisfactory completion of the above routine the 
officer should be detailed permanently to the Air Service in "such numbers as needed." 

He also recommended that: 

1. An additional officer for the office of the Chief of the Medical Section. 

2. The Chief of the Medical Section should always be a flight surgeon. 

3. Special funds should be sought for training reserve officers in aviation medicine. 

4. Select some flight surgeons who are specialists in fields important to aviation medi- 
cine, in order that they may be detailed to duty at the School of Aviation Medicine. 

5. The work of flight surgeons should be coordinated by some officer from the Medical 
Section or the School of Aviation Medicine. 

6. An officer should be sent to study the medical divisions of foreign air services. 



24 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

The suggestions made in the above letter have been quoted in some detail, 
for it appears that, in the main, they represented the thinking of the aviation 
medical officers in the 1920's. 

Transition From Peace to War 

During the next decade as the concept of military air power was being 
debated among both military and civilian leaders, the problem of medical 
support was largely theoretical. By 1939, however, it had become apparent 
that the airplane was a weapon of war as well as a luxury of peace. As the Air 
Corps expansion program got under way and as aircraft was equipped to fly 
with ever increasing speed and at higher altitudes, new problems emerged 
concerning the man who flew the planes. The responsibilities of the Medical 
Section of the Air Corps increased proportionately. Viewing the air medical 
organization in 1939, Maj. Gen. C. R. Reynolds, The Surgeon General, noted 
that it was actually comparable to an "Office of a Surgeon General for the Air 
Corps." 100 He proposed to centralize that service within the framework of 
the Army Medical Department as it had been during World War I. 

General Arnold, Commanding General of the Air Corps, who was aware 
that The Surgeon General desired the Medical Section transferred to his office, 
in March 1939 asked the views of Col. Malcolm C Grow, Chief Flight Surgeon, 
and Col. C. L. Beaven. 101 Colonel Grow, apparently feeling the advantages 
were obvious, presented an objective summary of advantages and disadvantages, 
but made no recommendation. Advantages listed for the plan of creating an 
Aviation Medicine Division in The Surgeon General's Office to incorporate 
the personnel and functions of the present Medical Section were as follows: 
(1) It would provide the necessary machinery for handling problems con- 
cerning the training of medical personnel, supplies, building, nurses, and 
statistical studies; (2) would acquaint The Surgeon General with the problems 
of the Air Corps, with the probability of his taking a greater interest in them ; 
and (3) would raise the present Medical Section to division status. He listed 
two disadvantages: (1) The Chief of the Air Corps would lose the close liaison 
and cooperation which existed between him and the Medical Section; and (2) 
there would be the danger of a non-flight surgeon being appointed as head of 
the Aviation Division. Colonel Grow suggested, however, that if the current 
system were retained, the Medical Section certainly should be elevated to 
division status. 

Colonel Beaven, on the other hand, made the definite recommendation 
that transfer to The Surgeon General be effected. 102 The Medical Section he 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



25 



said, had developed into an office comparable to that of a Surgeon General for 
the Air Corps but without the machinery to carry out its functions. Since 
The Surgeon General was responsible for all medical activities of the Army, 
in the final analysis the Chief of the Medical Section must appeal to him for 
personnel, supplies, and buildings. Much time was lost in referring problems 
to the Chief of the Medical Section which actually could be handled only by 
The Surgeon General, for purely medical matters "could not be passed upon by 
laymen." Since the Medical Section operated under the Personnel Division 
of the Training Branch, Office, Chief of the Air Corps, medical men hesitated 
to place themselves "under the jurisdiction of laity." Finally, the Air Corps 
expansion program would accentuate the weak position of the Chief of the 
Medical Section because he could do no more than make recommendations 
concerning medical needs. He recommended therefore that an Aviation 
Medicine Division be established in the Office of The Surgeon General and all 
personnel then on duty with the Medical Section be transferred to it; that, 
however, the physical location of the division in the Office, Chief of the Air 
Corps, be retained ; that physical examinations continue to be administered as 
at present; and that the Chief of the Aviation Division be a flight surgeon with 
experience with Air Corps troops and with considerable flying hours to his 
credit. While the problem was being considered, General Arnold acted upon 
Colonel Grow's single recommendation and issued an office memorandum 
which elevated the Medical Section to a division of the Training Group. 103 

Meanwhile the Grow-Beaven letters were analyzed separately and a sum- 
mation sent to Col. Carl Spaatz, Air Chief for Plans Division, in April, which 
said in part: 104 

(3) If office stays where it is but The Surgeon General acknowledges his responsibility 
for its functioning; 

(a) Air Corps should get better attention from Medical Corps and 

(b) Chief of the Air Corps should continue to have some control over and knowledge 
of physical status of Air Corps personnel and have facilities of responsible Medical officers 
available for consultation at all times. 

(4) . . . [Sic] I can see as a sole net result of Surgeon General's proposal that the 
Chief of the Air Corps loses absolutely nothing and gains a fuller helpfulness from the 
Office of the Surgeon General. 

There the matter rested for the next month. On 25 May 1939, however, 
the new Surgeon General, Maj. Gen. James C. Magee, took formal action on 
the matter. In a letter to The Adjutant General he stated his case at great 
length and concluded that the Medical Division should not exist apart from 
his office. 105 His views coincided with those advanced earlier to General 



26 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Arnold by Colonel Bevan. Specifically he recommended that: (i) The 
Medical Division of the Air Corps be discontinued and the personnel trans- 
ferred to his office; (2) a division of aviation medicine be established in the 
Office of The Surgeon General; and (3) the control and supervision of the 
School of Aviation Medicine be vested in The Surgeon General. 

In keeping with established procedure, The Adjutant General sent the 
letter in question to General Arnold for comment. Having by then carefully 
considered the matter for the past three months, the Chief of the Air Corps in 
June 1939 went on record as opposed to such a transfer. He put forth an able 
defense of the Medical Division as currently organized/ 08 pointing out that 
while the physical condition of flying personnel was a function of The Surgeon 
General, determination of the particular type of flying that an officer should 
be permitted to undertake was the function of the Chief of the Air Corps. It 
was necessary therefore that close cooperation be maintained at all times between 
Air Corps personnel and medical personnel, and this cooperation could be best 
secured under the existing medical organization. Moreover, the Air Corps, 
realizing that research was vital to its program, had expended funds to establish 
and operate the School of Aviation Medicine at Randolph Air Force Base, 
Texas, and the Aero Medical Research Laboratory at Wright Field, Ohio. 107 
With research activities directed by the Chief of the Air Corps who was also 
responsible for the Medical Division personnel of the same office, it was possible 
that a medical program might speedily be directed to the solution of vital Air 
Corps problems. Finally, he pointed out again the well-known fact that the 
major European powers followed the existing plan for air medical support. 
In conclusion he stated: 

The Chief of the Air Corps has no objection to the establishment of a Division of 
Aviation Medicine in the Office of The Surgeon General, provided it does not take over 
any of the functions now performed by the Medical Division, Office of the Chief of the Air 
Corps. It is strongly recommended that — 

a. The Medical Division as now organized in The Office of the Chief of the Air Corps 
be continued. 

b. The School of Aviation Medicine remain under the control of the Chief of the 
Air Corps. 

No further action was taken in the matter during the summer of 1939. 

In October of that year, however, an unfortunate incident occurred which 
strained the relationship between the Chief of the Air Corps and his medical 
adviser. General Arnold, on his way to the Philippines, stopped briefly in 
Hawaii. On the following morning when he was ready to depart, he learned 
that his pilots had been declared medically unfit for flying duty by Lt. Col. 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



27 



Eugen Reinartz, flight surgeon for the Hawaiian Department. General 
Arnold neverthelr ^ ordered the flight made. 

Upon his return to Washington the Chief of the Air Corps directed that a 
board of officers be appointed to study the "whole flight surgeon problem in the 
Air Corps." 108 This action took place at a staff meeting when, without previous 
discussion with the new Acting Chief of the Medical Division, Lt. Col. D. N. W. 
Grant, he directed Col. Ira C. Eaker, of his office, to appoint a board consisting 
of Grant as Chairman, Lt. Col. M. C. Grow, and Lt. Col. Fabian L. Pratt, 
to "render a report to him justifying the existence of flight surgeons." 109 He 
is reported to have commented further that: 110 

he had been trying to get a plan from the Flight Surgeons themselves for three years but 
that he had been unable to do so, that in the past he had been one of the greatest friends 
the Flight Surgeons ever had but that he was on the verge of being through with them, 
and unless something very definite was presented to him immediately he would recommend 
that they all be done away with. 

The Board, appointed on 12 October, met for the first time on 31 October 
at the Office of the Chief of Air Corps. 111 Its members decided to outline the 
general mission of the Medical Division of the Air Corps, together with the 
specific and secondary duties necessary for the accomplishment of this mission, 
and to determine, on the basis of the personal opinion of the members of 
the Board, the percentage of efficiency of current discharge of these duties. 112 

The general mission of the Medical Division was defined as the selection 
and classification of physically qualified candidates for flying cadet training 
and selection of physically qualified enlisted personnel for duty with the Air 
Corps; the preservation of the strength of officers and enlisted personnel in the 
Air Corps; the care and treatment of the sick and injured officers and men 
in the Air Corps; and, in time of war the conversion of casualties into replace- 
ments. Discussions of the Board concerning reasons for deficiencies revealed 
that the greatest single cause was a lack of personnel. For example, the program 
for preservation and care of flying personnel was rated as 50 percent efficient. 113 
It was stated that in view of the fact that 30 percent of the flight surgeon's time 
should be spent in observation of the flyers both on the ground and in the air, 
and that 10 percent more time must be spent on the specialized physical exami- 
nation than for non-Air Corps personnel — functions not required of other 
Medical Corps officers — there should be at least a 40 percent higher quota of 
medical officers for Air Corps stations than for non-Air Corps stations. 

Concerning the problem of transportation, evacuation, and limited hos- 
pitalization of personnel in time of war, 114 a direct warning of unpreparedness 
was given. 

262297°— 55 4 



28 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Research in aviation medicine, 115 it was stipulated, should be carried on by 
three agencies of the Air Corps, namely, the Aero Medical Laboratory at Wright 
Field, the School of Aviation Medicine, and by the individual flight surgeons. 
In the order of their listing, an efficiency rating on research only was given to 
each: 95 percent, 20 percent, and 10 percent. The chief reason for the low 
rating given to the School of Aviation Medicine was the fact that teaching 
required the greatest part of the time of the limited personnel, and it was 
recognized that flight surgeons, in general, had little time for research activities 
in addition to other duties. 

An average number of 10 Medical Corps officers was trained each year in 
aviation medicine over a period of 21 years. 110 The Board believed this number 
should be increased to 36 officers of the Regular Army, 27 for Reserve and 
National Guard officers, and, in addition, that 80 enlisted men should be trained 
as assistants to flight surgeons. It was suggested that this program be carried 
out by the School of Aviation Medicine. It was also recommended that other 
Reserve and National Guard officers be trained in the branches of the School 
of Aviation Medicine if necessary funds could be made available. Dissatis- 
faction was expressed with the training of Medical Corps officers for field service 
with the Air Corps, 117 with this function receiving a 20 percent efficiency rating. 
It was recommended that this training be made the responsibility of the group 
and squadron surgeons; and, further, that it be instituted in all units of the 
Air Corps and not solely in the GHQ Air Force. 

The Board considered the reasons for low morale on the part of flight 
surgeons. 118 First was the lack of personnel to provide the service expected of 
flight surgeons. In the past the flight surgeon had been used as a punitive or 
disciplinary agency, and in some cases flyers were removed from flying status 
for physical reasons when the cause should have been poor technical flying 
ability. A second factor was that of limiting flying pay to $60 per month while 
non-Air Corps observers were being paid $120. Finally, there was the problem 
of increased premium for insurance even if on flying status only one month in 
a year. Along this line certain difficulties were recognized in the matter of 
recruiting young medical officers for flight surgeons. 119 The monthly compen- 
sation of $60 for irregular flying duty was considered inadequate for risks 
involved. Inequality in pay ratios between flight surgeons and flying personnel 
militated against social contacts between the two groups. There was always the 
possibility of assignment to Air Corps stations where opportunities for practice 
of specialized surgery would not be available. Nor was there assurance that 
medical officers would remain with the Air Corps after they took the necessary 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



29 



training. Moreover, there was always the knowledge that an insufficient 
number of personnel was on duty at Air Corps stations. 

Finally, somewhat apart from these considerations, the Board included in 
its recommendations a request for suitable insignia to be worn by flight surgeons. 
These insignia were later authorized. 120 

With all these factors in mind, the Board submitted recommendations 
designed to implement its discussions, 121 and action was being taken on them 
as early as 17 January 1940/ 22 although much of the program obviously was 
dependent upon an increase in medical personnel. 

News of General Arnold's sudden appointment of a board to study the 
"whole flight surgeon problem" meanwhile reached The Surgeon General 
within a short time. He apparently believed this an auspicious time to renew 
his effort toward centralizing medical activities, and accordingly carried the 
case to the War Department General Staff, G-3; for on 16 October, four days 
after the Board was appointed, G-3 asked General Arnold to reconsider his 
25 May letter. 123 

General Arnold referred the matter to the Board which prepared an answer 
in the form of a study. 124 Certainly it must have been a time of tension among 
the members of the Board. As members of the medical profession, they had just 
witnessed in Hawaii what could happen when lay control was exerted over 
what was considered a medical matter in the case of the grounded flyers. At 
the same time, there was the potential problem of whether The Surgeon 
General, himself not a flight surgeon, would in the future be able to understand 
the medical problems of the man in the plane. Faced with this dilemma, the 
Board prepared a lengthy answer based primarily upon an analysis of The 
Surgeon General's earlier communication of 25 May. It included both a 
majority report and a minority report, for the board members could not agree 
among themselves. 

The majority report, signed by Colonel Grow and Colonel Pratt, favored 
retaining the present organization. In the draft of the suggested memorandum 
written by Colonels Grow and Pratt for G-3, there was a detailed analysis of 
The Surgeon General's letter of 25 May 1939. The position of The Surgeon 
General had been summarized in these words: 

. . . the presence of the Medical Division of the Office, Chief of the Air Corps, is unneces- 
sary, is administratively unsound, is a potential source of misunderstanding, tends to 
circumvent the advisory duties of The Surgeon General and that no peculiar administrative 
problems of a medical nature are charged to the Chief of the Air Corps that difler from other 
Branches of the Army. 



30 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



In answer, it was argued that, since "the Chief of the Air Corps is charged with 
the flying efficiency and flying status of the entire flying personnel of the Air 
Corps," and since flying efficiency and physical condition were so intimately 
associated, a unique medical problem which was peculiar to the Air Corps 
did indeed exist. It was denied that staff liaison duty "leads to inevitable 
divergence of allegiance and misunderstanding." Liaison was an accepted 
practice of the War Department and should neither be a cause of misunder- 
standing nor lead to divided allegiance of personnel. As a matter of fact, 
various reports from the Medical Division should keep The Surgeon General 
informed about aviation medical matters; and other purely liaison functions 
of the Medical Division which were concerned with hospital construction, 
medical personnel, and training of Medical Department personnel were matters 
about which The Surgeon General would be kept informed through regular 
reports. The majority report summarized the functions of the School of 
Aviation Medicine which showed that it dealt only with matters pertaining to 
aviation medicine and should therefore remain under the control of the Air 
Corps. An outline of the duties of the senior flight surgeon and his assistants 
was included, together with a prescribed field of research for the Aero Medical 
Research Laboratory at Dayton, Ohio. Attention was called to the fact that 
during the entire existence of the Medical Division — approximately 20 years — 
no definitive directive of activities or policies had been issued. It was believed 
that a clear cut directive from the Chief of the Air Corps would solve the 
present apparent difficulties, and a directive from the Chief of the Air Corps 
defining the duties of, the Medical Division was promised. It was recom- 
mended that The Surgeon General issue a like directive concerning a Division 
of Aviation Medicine in his office, if organized, so that there would be no over- 
lapping in the functions of the two offices. If such a division were organized 
in The Surgeon General's Office, the chief should be a flight surgeon with 
8 years of experience with the Air Corps. 125 

The chairman, Colonel Grant, failing to concur in the study for General 
Arnold, wrote a minority study expressing his views. 126 To understand the 
reason for this, it is necessary to reconstruct a part of the background. In the 
first place, Colonel Grant, then on duty at Barksdale Field, Louisiana, had been 
asked by Colonel Beaven, Chief of the Medical Division, to accept duty as his 
assistant. Before Colonel Grant reported for duty, Colonel Beaven entered 
Walter Reed Hospital for treatment. 127 Colonel Grant, at that time unfamiliar 
with Headquarters staff plans and policies, was nevertheless expected to 
carry out the policies of his Chief, who was already on record as favoring the 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



31 



transfer of the Medical Division and the School of Aviation Medicine to the 
Office of The Surgeon General. 128 It may in fact be assumed that the views of 
Colonel Beaven in this matter were partially responsible for his appointment as 
Chief of the Medical Division, for along this line, General Arnold later wrote: 
"It is my opinion that the choice of Colonel Beaven was more or less of a personal 
matter with The Surgeon General's Office." 129 It may be just as safely assumed 
that Colonel Grant's appointment as an assistant to Colonel Beaven was likewise 
a personal matter between Colonel Beaven and The Surgeon General, for 
Colonel Grant, well known specialist and administrator, would add stature 
to the office. 130 General Grant, queried about this after his retirement, stated 
that the first he knew of the pending appointment was when Colonel Beaven 
phoned asking that he come to Washington, and that when he was suddenly 
called upon to serve in his place, he naturally followed the policy of the Division 
Chief. 131 This background thus throws considerable light on the minority 
study prepared by Colonel Grant for the Executive of the Air Corps. 132 

Reference was made in this minority study to the misunderstandings result- 
ing from the controversy over the duties and functions of the Medical Division, 
Office of the Chief of the Air Corps, and it was suggested that the whole matter 
be settled by mutual agreement between the Chief of the Air Corps and The 
Surgeon General. These points were stressed : 

1. Due to the assumption by the Medical Division of duties and responsibilities not 
originally intended, the flight surgeon felt that he was serving with a separate medical 
organization and hence was divorced from his own branch. 

2. The crux of the controversy was concerned with the question: "Under whose juris- 
diction should the physical examination for flying be conducted, the Chief of the Air Corps 
or The Surgeon General?" When in making periodical physical examination the flight 
surgeon's professional opinion differed from that of lay opinion, tremendous pressure was 
leveled against the flight surgeons. 

In contrast with the recommendations of Colonels Grow and Pratt, Colonel 
Grant suggested that the School of Aviation Medicine be made a part of the 
school system of the Medical Department inasmuch as the present system of 
one arm running a school for another arm was unsound. Presumably this 
arrangement was agreeable to Colonel Grant. 

As the year drew to a close the problem remained unsettled. The Surgeon 
General, however, initiated a series of conferences between representatives in 
his office and the Air Corps and, in a memorandum to General Arnold dated 



32 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



24 January 1940, summarized the agreements which he understood had been 
reached. 133 This summary included the following: 

1. All G-3 and G-4 medical matters were functions of The Surgeon General. 

2. The School of Aviation Medicine was to be transferred to The Surgeon General. 

3. The medical research activities at Wright Field were to remain under control of 
the Chief of the Air Corps. 

4. The personnel on duty in the Medical Division should be transferred to The Surgeon 
General. 

5. The part of the division engaged in making recommendations relative to the 
physical status of fliers would be located in office of the Chief of Air Corps. 

6. The Chief of the Division of Aviation Medicine would have a desk in the Office of the 
Chief of the Air Corps and the Office of the Surgeon General. 

7. All records of physical condition of flying personnel would remain in the Office of 
the Chief of Air Corps. 

8. No agreement was reached in connection with the assignment of a medical officer 
on the personal staff of the Chief of the Air Corps. However, as a tactical commander, the 
Chief Surgeon of the GHQ Air Force served in this capacity; but concerning the rela- 
tionship of the Chief of the Air Corps to the Air Corps at large, there was the same relation- 
ship that existed between other chiefs and their branches. They had no medical officers 
assigned to their staffs and hence there was no occasion for one to be assigned to the Chief 
of the Air Corps. 

9. The Chief of the Division of Aviation Medicine would be a member of the staff 
of The Surgeon General. 

Taking immediate exception to The Surgeon General's limited interpreta- 
tion of the scope of the Chief of the Air Corps mission, General Arnold sent the 
memorandum to Plans Division for comment. His concern in the matter was 
expressed in a letter dated 29 January, 5 days after he had received The 
Surgeon General's letter. On that date he wrote: "This whole matter of flight 
surgeons is now in a state of flux and I am free to admit that I don't know 
exactly how it is coming out." 134 Meanwhile, Colonel Spaatz of Plans Division 
indicated the need for organic medical support in the Air Corps expansion 
program. He wrote: 135 

For immediate disposition of this matter, recommend no change be made at this time 
in administrative or organizational control of Flight Surgeons actvities, owing to: 

a. Desirability of avoiding all but mandatory changes during first two years of 
Expansion Program. 

b. Possibility of establishment of semiautonomous aviation organization within the 
War Department, as under consideration, which will necessitate absolute control over Flight 
Surgeons and their activities. 

General Arnold based his reply to The Surgeon General upon Colonel 
Spaatz's suggestions and recommended that, since the expansion program was 
under way, and since complete agreement was impossible at the time, no changes 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



33 



be made prior to 30 June 1941, when the expansion program would be con- 
cluded. 136 This recommendation followed the further advice of Colonel Spaatz, 
who had pointed out that if the organizational changes under consideration by 
the War Department were effected, it would necessitate the "absolute command 
control" of all flight surgeons by the Air Corps. 

The anticipated action of the War Department on the Air Corps organiza- 
tion plan was concluded on 20 June 1941, 137 at which time the Army Air Forces 
was established. The new organization consisted of Headquarters Army Air 
Forces, composed of the Chief of the Army Air Forces and his staff; the Air 
Force Combat Command, composed of the Commanding General and his 
staff; and the Air Corps, composed of the chief and his staff. Additional 
authority was given to the Commanding General of the Air Force Combat 
Command and the Chief of the Air Corps over personnel assigned to them. For 
example, the Commanding General of the Air Force Combat Command was 
delegated "command and control of all Air Force Combat Command stations 
(air bases) and all personnel, units and installations thereon, including station 
complement personnel and activities." 138 A like delegation of authority over 
Air Corps stations was made to the Chief of the Air Corps. 139 As a result of this 
action, it was obvious that the medical personnel at these various stations must 
now be controlled by the Army Air Forces, and it ended, so far as the Army 
Air Forces was concerned, any inclination to incorporate the Medical Division 
into the Office of The Surgeon General. The problem of jurisdictional 
authority now was not between the Commanding General, AAF, and The 
Surgeon General, but among the components of the Army Air Forces. 

The Surgeon General, immediately recognizing the changed status of the 
Army Air Forces, recommended to The Adjutant General, after a conference 
in the office of the Commanding General, that the Medical Division in the 
Office of the Chief of the Air Corps be transferred to the Chief of the Army Air 
Forces. In addition, The Surgeon General advised that his office planned to 
"decentralize the Medical Department in a similar manner to the present 
decentralization to Corps Areas," and that all communications concerning 
Medical Department matters would pass through the Medical Division of the 
Army Air Forces. 140 The Chief of the Air Staff accepted The Surgeon General's 
plan for decentralizing Medical Department personnel to the Medical Division, 
but objected to the transfer of the Medical Division to Headquarters, Army 
Air Forces, 141 since it was a small organization having as its chief function that 
of medical planning for the Air Force Combat Command and the Air Corps. 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



35 



services; yet recommendations on medical questions for the Air Forces as a whole 
must go through two staffs. Besides caring for the sick, there was the additional 
problem of selection and care of the flyer. Finally, medical channels of com- 
munication within the Air Forces had been done away with, resulting in the 
confidential examination, WD AGO Form 64, being frequently sent through 
command channels and thereby violating its confidential nature. Full consid- 
eration of these problems had led to the conviction on the part of the Chief of 
the Medical Division that a centralized medical organization must be established 
for the Army Air Forces, and he recommended that such a medical service be 
organized under the control of the Chief Surgeon, Army Air Forces, who would 
be responsible to the Commanding General, Army Air Forces, for the medical 
service within his command. The Chief Surgeon would serve in an advisory 
capacity as a special staff officer to the Commanding General and in an ad- 
ministrative capacity in his conduct of the Medical Department as a technical 
service. 

The pattern of development which was destined to result in an over-all 
medical service for the Army Air Forces began to take shape when on 30 
October 1941 Colonel Grant was relieved from assignment and duty in the 
Office of the Chief of the Air Corps, assigned to the Headquarters, Army Air 
Forces, then reassigned to the Chief of the Air Corps in addition to his other 
duties. 146 On the same day a special order issued by the Army Air Forces 
designated Colonel Grant "The Air Surgeon." 147 As a result of these orders, 
Colonel Grant held two offices. He was Air Surgeon attached to Headquarters, 
Army Air Forces. At the same time he was Chief of the Medical Division in 
the Office of the Chief of the Army Air Forces, but attempting to carry out 
his duties in the Medical Division which operated under the Chief of the Air 
Corps, a lower echelon. The difficulties of this arrangement are obvious ; besides 
which Major General Brett, Chief of the Air Corps, objected to the arrangement 
because he felt that the control of the Medical Division was being diverted from 
his office. 148 There was, of course, logic to his position since routine medical 
duties had been delegated to his office in July 1941, including the authority to 
"Supervise the necessary medical services for the Army Air Forces . . 149 

The next study designed to remedy his administrative difficulties was sub- 
mitted by Colonel Grant to the Chief of the Army Air Forces on 30 January 
1942. 150 It was suggested in this study that the medical service be made a basic 
division of the Army Air Forces, to be administered by the Chief Surgeon. 
The Chief Surgeon would be answerable to the Chief of the Army Air Forces 
"and would bear the same relation to surgeons of subordinate units as now 
exists between The Surgeon General and the Surgeon of a Field Army." Echo- 



34 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



On ii July 1941, only 4 days after the indorsement to The Surgeon 
General's letter rejecting the recommendation that the Medical Division be 
transferred to the Headquarters of the Army Air Forces, a study emanated from 
the Medical Division, concurred in by the Chief of the Division, stating that a 
reorganization was necessary so that the medical services of the entire Army Air 
Forces would be under one responsible head. 142 This was not possible at present 
because the Chief of the Air Corps and the Chief of the Air Force Combat 
Command were on the same echelon; hence, the Medical Division of the Air 
Corps lacked authority to control the medical organization of the Combat 
Command. It was noted that the same situation had existed before when the 
GHQ Air Force was on the same echelon as the Air Corps. As a result of 
the current situation, it was recommended that the present Chief of the Medical 
Division be made "Chief Surgeon, Army Air Forces," thus enabling him to 
function in a staff status and at the same time administer the medical services 
of both the Air Corps and the Air Force Combat Command. Yet, paralleling 
the plea for a redelegation of power which would permit a centralized control 
of the whole medical program for the Air Forces, the study recommended that 
the Medical Division as such remain under the Chief of the Air Corps, for 
sections of this office already existed and could administer the medical services 
for both the Air Corps and the Air Force Combat Command, if only such power 
were delegated to it. Thus, apparently, the only admitted reason for having 
objected to the transfer of the Medical Division to the Headquarters, Army Air 
Forces, was the fact that an organization already existed in the Medical Division, 
an argument which was meaningless since the organization could have been 
transferred en bloc as was actually done later when the Medical Division was 
transferred to Headquarters and made a section of the Air Surgeon's Office. 143 
Another possible explanation of the recommendation that the Medical Divi- 
sion be retained under the Chief of the Air Corps lies in the anticipated attitude 
of Maj. Gen. G. H. Brett, Chief of the Air Corps, toward such a transfer. It 
is significant in this connection that he opposed the plan referred to above in 
these words: "Don't agree. The Air Corps is the services [sic] for the entire 
Air Force and therefore the Medical Division cannot function in that capacity 
with designation as such. Another case of dual head." 144 

Before many weeks had passed, however, the Chief of the Medical Division, 
Colonel Grant, realized that his medical organization must be removed from the 
control of the Chief of the Air Corps. In a memorandum dated 30 September 
1941, he pointed out that this situation had led to "administrative embarrass- 
ment" in connection with the medical service. 145 It was noted that the great 
expansion of the Air Forces had necessitated a corresponding increase in medical 



36 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

ing the early arguments of The Surgeon General, Colonel Grant now denied 
that the Medical Division, Office Chief of the Air Corps, was the operating 
agency for the Army Air Forces medical service, since its only legal authority 
was to pass on physical qualifications of flying personnel. Other duties had 
been assumed without authority, it was argued, and The Surgeon General's 
Office was still the operating agency of the Army medical service including 
the Army Air Forces. He recommended therefore that the duties, functions, 
and personnel of the Medical Division, Office of the Chief of Air Corps, be 
transferred to an Office of the Air Surgeon. 151 The recommended action was 
taken and orders issued from The Air Adjutant General's Office on 6 February 
1942 which transferred the Medical Division en bloc to Headquarters, Army 
Air Forces, and designated it a section of the Office of the Air Surgeon. 152 The 
final step was taken when the commissioned personnel were relieved from duty 
in the Office of the Chief of the Air Corps and directed to report to the Chief of 
the Army Air Forces. 

With the issuance of the order transferring officer personnel of the Medical 
Division, Office of the Chief of the Air Corps, to the Air Surgeon's Office, 
centralization of the medical service was almost complete. 153 It was not, how- 
ever, until the 9 March 1942 reorganization of the War Department became 
effective that the medical activities of the Air Force Combat Command were 
transferred to the Air Surgeon. That reorganization as defined in War Depart- 
ment Circular No. 59, dated 2 March 1942, established the three major divisions 
of the Army — the Army Ground Forces, the Army Air Forces, and the Services 
of Supply 154 — and as a result the Army Air Forces was accorded co-equal status 
within the War Department. 155 There was a regrouping of the "functions, 
duties, and powers" of various chiefs of arms under the three major divisions; 
and as affecting the Army Air Forces, the "functions, duties, and powers of the 
Commanding General, GHQ Air Force (Air Force Combat Command), and 
the Chief of the Air Corps" were "transferred to the jurisdiction of the Com- 
manding General, Army Air Forces." 156 Specific duties were assigned to the 
Army Air Forces one of which was of particular interest to the Air Surgeon. 
This duty involved the "command and control of all Army Air Forces stations 
and bases not assigned to defense commands or theater commanders and all per- 
sonnel, units, and installations thereon, including station complement personnel 
and activities." 157 In short, this provision delegated command responsibility 
for medical personnel assigned to Air Force stations. 

Inasmuch as changes were made in the organization and the functions of 
the Army Air Forces by War Department Circular No. 59, it became necessary 
to redefine medical duties. On 9 March 1942, the effective date of the War 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



37 



Department reorganization, General Arnold charged the Air Surgeon with the 
following functions, to be exercised under the direction of the Chief of the 
Air Staff: to advise as to total Army Air Forces requirements for medical 
services, including personnel, supplies, and facilities; to advise on professional 
standards for medical personnel and on physiological standards for all per- 
sonnel of the Army Air Forces; to plan and direct programs of research in 
the physiology of flight to serve as a basis for aircraft design and the establish- 
ment of physical standards for Army Air Forces personnel; to direct the School 
of Aviation Medicine; to exercise technical supervision of all flight surgeons in 
the Army Air Forces; and to assume all activities of the Medical Section, Head- 
quarters Army Air Force Combat Command. 158 The transfer of three officers 
from the Medical Section of the Headquarters, Air Force Combat Command, 
was ordered along with the transfer of activities. The Medical Department of 
the Air Forces was therefore now centralized in the Office of the Surgeon, 
which office operated under the control of the Commanding General of the 
Army Air Forces. 

Since the relationship between The Surgeon General and the Air Surgeon 
was not clearly defined at the time of the March 1942 War Department reorgani- 
zation, The Surgeon General initiated a movement to have it defined by the 
proper authorities, upon the basis of his own recommendations. He pointed 
out to the Commanding General, Services of Supply, to whom he reported, 
that the provisions of the circular did not change the relationship which had 
existed theretofore between the Medical Department and the previous Air Corps 
organization, a relationship which was described as follows: 159 

2 a. The routine conduct of the Medical Department with the Army Air Forces shall 
be the responsibility of the local surgeon acting through The Air Surgeon who is responsible 
to The Surgeon General for the efficient operation of the Medical Department with the 
Air Forces. 

# # # * # # * 

c. In the discharge of his duties the Air Surgeon will utilize the services available in 
the Services of Supply to the maximum degree consistent with the proper control of the 
Medical Department within the Army Air Forces. No activity of the Office of The Surgeon 
General will be duplicated, with the exception of those procedures necessary for the proper 
control of Medical Department personnel while under the jurisdiction of the Army Air 
Forces. 

This plan of operation met the approval of the Commanding General of 
the Army Air Forces with the exception of minor changes which were agreed 
to by the Services of Supply. These changes involved the substitution of "under" 
for "through" in paragraph 2. and "activities" for "personnel" in paragraph 
2. r. 160 Hence, the local surgeon would act under instead of through the Air 



38 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Surgeon; and the use of "Medical Department activities" instead of "Medical 
Department Personnel" seemed to be more definitive. As a matter of fact, 
G-3 included both terms and the statement read: "No activity of the Office of 
The Surgeon General will be duplicated, with the exception of those procedures 
necessary for the proper control of Medical Department personnel and activities 
under the jurisdiction of the Army Air Forces." 161 

The agreement reached by the Army Air Forces and the Services of Sup- 
ply concerning medical activities was approved by G-3 on 23 April 1942 and 
made the subject of a memorandum of the same date. 162 There were additional 
provisions supplementing the original agreement which may be paraphrased 
as follows : 163 

1. Medical operations would not interfere with command functions of the Command- 
ing Generals, Army Air Forces and Army Ground Forces. 

2. The Air Surgeon would operate in advisory and administrative capacities — advisory 
in his relation as a staff officer and administrative in his conduct of Medical Department 
technical service under the control of the Commanding General, Army Air Forces. 

3. The Commanding General, Services of Supply, might direct technical inspections 
of Air Force stations and commands for the purpose of determining the status of Medical 
Department activities. Reports would be made to the Commanding General, Army Air 
Forces, for corrective action. 

4. Medical equipment and supplies for Army Air Forces would be furnished by the 
Services of Supply insofar as practicable. 

When a copy of this agreement of 23 April 1942 was sent to all Corps Area 
Commanders, a part of the original paragraph 4. i was omitted which read: 
"No activity of the Office of The Surgeon General will be duplicated, with the 
exception of those procedures necessary for the proper control of Medical 
Department personnel while under the jurisdiction of the Army Air Forces." 164 
On 4 June 1942 the paragraph was amended by this addition: "and of Medical 
Department activities under the jurisdiction of the Army Air Forces/' 165 

The Army Air Forces had thus made considerable progress in developing 
its wartime medical service program now that the guiding principle had been 
defined by War Department directive. The problem now was to reach a 
mutual agreement with the Army as to what Medical Department activities 
were under the jurisdiction of the Army Air Forces. 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 




40 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



NOTES TO CHAPTER I 

*WD, Office Memo, Office of the Chief Signal Officer, i Aug 1907, quoted in C. de F. Chandler, 
and Frank P. Lahm, How Our Army Grew Wings, (New York: 1943) PP- 80-81. 
2 Chandler and Lahm, op. cit., p. 80. 
8 38 Stat. 515, 18 July 1914. 
4 39 Stat. 174, 3 J^e 191 6. 

B Lt. Col. C. L. Beaven, A Chronological History of Aviation Medicine, (Randolph Field, Texas, 1939) 
pp. 4-6. 

a Harry G. Armstrong, Principles and Practice of Aviation Medicine, (Baltimore, 1952, Third Edition) 
p. 26. The first edition was published in 1939. 

* Ibid., p. 27. 

* Notes of Col. William Lyster quoted in W. H. Wilmer, "The Early Development of Aviation Medicine 
in the United States," in The Military Surgeon, LXXVIl; (3 Sept 1935), pp. n 5-1 16. 

•ibid., p. 116. 

"WD SO No. 246, par. 47, 20 Oct 1916. 
11 Armstrong, op. cit., p. 27-28. 
" Quoted in Wilmer op. cit., p. 1 1 6. 

"Isaac H. Jones, Flying Vistas (Philadelphia, 1937), pp. 179-183. Col. Eugene R. Lewis, in a signed 
marginal note on p. 183 of the above reference, says: "Major Paul S. Halloran collaborated with other 
Medical Corps officers in circa 191 4 on a special physical exam — the prototype of '609'." 

14 War Department: Air Service, Division of Military Aeronautics, Air Service Medical, (Washington: 
1919). It is interesting to note that no changes were made in the examination during World War I and 
that it was almost identical with the form which was used by the Army, Navy, and Marine Corps in 
World War II. 

" Ibid., p. 183. 

" Ibid., pp. 183-187. 

"Col. William N. Bispham (MC), The Medical Department of the United States in the World War, 
Vol. 1, The Surgeon General's Office, (Washington: 1923) pp. 495-496. 

""Annual Report of Director of Military Aeronautics," 3 Sept 191 8. The Medical Department in 
Stencil No. 1092 claimed that approximately 100,000 applicants were examined in a little over seven months, 
with rejections averaging 75 percent. These data were severely criticized in a memorandum from the 
Signal Corps to the Chief of Air Service, n May 191 8. Records of the Personnel Section, Air Service, 
showed that only 20,485 had been passed from the time physical examinations were first made, and that 
total examinations for the same period were less than 50,000. However, after the war, Colonel Lyster 
insisted on using the 100,000 figure in his contribution to the medical history of the war. 

" Arthur Sweetser, The American Air Service, (New York, 191 9) p. 102. 

" Data given in a letter from Chief of Medical Division to Dr. Issac H. Jones, 30 Mar 1934. 

n Armstrong, op. cit., pp. 28-29. 

22 "Annual Report of Director of Military Aeronautics," 3 Sept 191 8. Although there are some 
difficulties in making a comparison with the records in the World War II training program, it may be 
worthwhile. In contrast, during calendar year 1943, the total number of flying hours in the United States 
was 32,064,789 with total fatalities of 5,603, or an average of 5,722 flying hours for each fatality. (See: 
Hq AAF, Office of Flying Safety, "Flying Accident Bulletin Continental U. S. 1943 and First Quarter 1944".) 

33 Armstrong, op. cit., p. 29. 

24 Wilmer, op. cit., pp. 116-117. 

"As cited Armstrong, op cit., p. 27. Col. William N. Bispham (MC), The Medical Department of 
the United States Army in World War 1, Vol. 7, Training (Washington: 1927) p. 499. 
" Wilmer, op. cit., p. 1 17. 
"Ibid. 

"WD SO No. 113, 18 Oct 1917. 
" Beaven, op. cit., p. 10. 

80 Armstrong, op. cit., p. 29. 

81 Armstrong, op. cit., p. 41. 

82 WD SO No. 207, 6 Sept 1917. 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



41 



88 Air Div. Memo No. 1,19 Sept 1917. 

84 Ltr., Col. T. C. Lyster to CG, Air Div., 11 Oct 1917. A note on this letter states that it was delivered 
personally by Col. T. C. Lyster, 12 Oct 191 7. 
88 Ibid. 
"Ibid. 

87 1st ind. (basic ltr., Col. T. C. Lyster to CG, Air Div., 11 Oct 1917), Administrative Div., 12 Oct 1917. 
38 Air Div. Memo No. 15, 9 Jan 1918. 

88 Ltr., Chief Surgeon to TIG, U. S. Army, 30 Apr 1918. 

40 Medical Corps: Col. T. C. Lyster, Chief Surgeon; Col. George H. Crabtree, Assistant Chief Surgeon, 
Executive and in charge of Personnel; Lt. Col. Nelson Capen, in charge of Sanitation and Supplies; Lt. Col. 
S. M. DeLoffre, Hospitals; Maj. Isaac H. Jones, Care of the Aviator. Sanitary Corps: Maj. Albert A. Roby, 
in charge of sanitary personnel; Capt. John W. Cleave, in charge of enlisted personnel; Capt. Edgar T. 
Hitch, in charge of reports, returns, and property. 

41 Ibid. 

42 Ltr., TAG to Chief Signal Officer, 9 May 1918. 
48 WD SO No. in, Par. 253, 11 May 1918. 

44 WD SGO, Office Order No. 33, 11 May 1918. 

"Ltr., Col. T. C. Lyster to CG, Air Service Division, 14 May 1918. It should be noted that the 
arguments given by Colonel Lyster in the letter mentioned above, when both the Aviation Service and its 
medical organization were in their infancy, were the same used later at various times to substantiate a 
separate medical department for the Army Air Forces. 

46 1st ind. (basic ltr., Col. T. C. Lyster to CG, Air Serv. Div., 14 May 191 8) by Chief, DMA, 14 May 
1918. 

47 40 Stat. 556, 20 May 1918. 

48 Ibid., Sec. 3. 

"Executive Order No. 2862, 20 May 1918. 

80 Memo, for AG C/S from WD, 22 May 1918. 

61 See n. 18. 

" WD G. O. No. 19, Sec. 4, 29 Jan 1919. 

83 DMA Office Memo No. 1, 21 May 1918. 

84 Memo, DMA, for all Sections, 24 May 19 18. 

85 See n. 53 above. 

88 General Reference Chart of the DMA, 27 July 191 8. 

"SGO Air Serv. Div. to Director of Mil. Aeronautics, 20 June 1918. Also letter from Gen. Kenly 
to Rep. F. H. La Guardia, 9 Dec 191 8. 

88 WD SGO Order No. 135, 14 Mar 1919 

89 Jones, op. cit., pp. 188-189. 
60 See n. 18. 

81 Ltr., Chief Signal Officer to TAS, 1 1 Oct 1917. 

62 Hq., American Expeditionary Forces, G. O. No. 80, 21 Dec 191 7. 
83 Ltr., Chief Surgeon to CG, L. of C, 31 Dec 1917. 

84 1 st ind. (basic ltr., Surgeon to CG, L. of C, 31 Dec 1917) Hq. L. of C, A. E. F. France to C-in-C, 
A. E. F. 

88 Ltr., Chief Surgeon, A. E. F., to C-in-C, A. E. F., 5 Jan 1918. 

88 2d ind. (basic ltr., Chief Surgeon, A. E. F., to C-in-C, A. E. F., 5 Jan 1918) Hq., A. E. F„ C-in-C, 
A. S. G. S., to C. A. S., 12 Jan 191 8. 

87 Ibid. 

88 Air Serv. Office Memo, 15 Jan 1918. 
88 Jones, op. cit., p. 205. 

70 "Report from one of our Officers" quoted in Air Service Medical, pp. 121-122. The report bears no 
name, but it is safe to assume that it was written by Major Jones, since he was in charge of the "Care of the 
Flier" unit for the United States. 

71 The term "flight surgeon" was originated by Maj. Isaac Jones and Col. E. R. Lewis. Jones, op. cit., 
p. 210. 

n Wilmer, op. cit., pp. 118, 120. 



42 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



78 Jones, op. cit., p. 21 1. 

M WD SGO, Air Serv. Div., Memo No. 79, 3 June 191 8. 
n Ibid. 

76 Wilmer, op, <r/*/., 132. 

77 Aviation Medicine in the A. E. F., Director of Air Service, War Department (Washington; 1920), 
pp. 16-17. 

18. 

79 Armstrong, op. cit., p. 42. 

80 Ltr., Gen. Eugen G. Reinartz to Gen. H. H. Arnold, 18 Nov 1944. 
81 Ltr., Gen. H. H. Arnold to Gen. Eugen G. Reinartz, 31 Oct 1944. 
M WD SGO, Office Order No. 135 (n. d.). 

83 Ltr., Col. T. C. Lyster to CG, Air Serv. Div., 14 May 191 8. 

^Annual Report of the Chief of the Air Service, 1922. Reorganization became effective I Dec 1921. 
m Memo, for C/S from G-i, 2 Dec 1927. 

88 OCAC, Office Memo No. 10-5, 26 June 1929. Change became effective 1 July 1929. 

87 Annual Report of The Surgeon General of the United States Army, 1936, p. 207. 

88 OCAC, Office Memo No. 10-10E, 31 Mar 1939. Became effective 1 Apr 1939- 

89 Annual Report of The Surgeon General of the United States, 1939, p. 259. 

90 Memo for Chiefs of all Divisions, from Col. Ira C. Eaker, 12 Sept 1939. 

91 AAF SO No. 51, par. 1, 30 Oct 41. He had succeeded Col. C. L. Beaven who in turn had succeeded 
Lt. Col. Grow (now Flight Surgeon of the III AF). 

93 OCAC Office Memo No. 10-10F, 16 Feb 1942. The A AG Ltr. directing the transfer was dated 
6 Feb 1942. 

93 Ltr., Gen. Mason M. Patrick, Chief of the Air Corps, to TAG, 19 Dec 1924. 

94 Attached to Memo for the Executive from Chief, Medical Section, 15 Jan 1925. 
"Ibid. 

96 Ltr., Flight Surgeon I. B. March to CO, Mitchel Field, N. Y., 7 Oct 1925. 

97 WD SGO, Office Memo, 9 Nov 1925. 

08 Memo for the Executive, SGO, from Col. W. R. Davis, 17 Nov 1925. 

"Memo for the Executive, SGO, from Maj. L. H. Bauer, 14 Nov 1925. Major Bauer who had been 
Commandant of the School of Aviation Medicine since 1919 had left in September 1925 to become Medical 
Director of the Aeronautical Branch of the Bureau of Air Commerce. In 1926 he was to publish the first 
text book on Aviation Medicine in the United States. 

100 Memo for Chief of the Air Corps from Lt. Col. C. L. Beaven, 30 Mar 39. On 1 Mar 1935 the GHQ Air 
Force was organized in accordance with the recommendations of the Baker Board. According to The Army 
Air Forces in World War II, Vol. I, the official history of the AAF, "Tactical units scattered through the nine 
corps areas were assigned to the GHQ Air Force, with Headquarters at Langley Field; its three wings were 
located at Langley (Va.), Barksdale (La.), and March (Calif.) fields. As Commanding General, GHQ 
Air Force, Maj. Gen. Frank M. Andrews was responsible for organization, training, and operation of the 
force, reporting to the Chief of Staff in peace, the commander of the field forces in war. The Chief of 
the Air Corps, Maj. Gen. Oscar Westover, retained responsibility for individual training, procurement, and 
supply. Administrative control of air bases remained in the hands of the several corps area com- 
manders." (P. 31.) 

101 Memo for the Chief of the Air Corps from Col. M. C. Grow, 10 Mar 1939. 

102 See n. 19. 

103 See n. 88. 

104 An unsigned draft dated 11 Apr 1939. Attached to it is a memo slip for "Col Spaatz — For use in 
your consideration of the flight surgeon problems," initialed by Gen. Yount. 

108 Ltr., SGO to TAG, 25 May 1939. 

108 2d ind. (basic ltr., SGO to TAG, 25 May 1939), General Arnold to TAG, 23 June 1939. 

107 See Chapters III and IV. 

108 Information obtained from an interview with Maj. Gen. D. N. W. Grant, TAS, 20 Jan 1945. 
Reaffirmed in interview with Gen. Grant by Mae M. Link, 1 Apr 1953. 

100 Ltr., Col. D. N. W. Grant to Col. C. L. Beaven, 14 Oct 1939. Grow was then flight surgeon at 
Langley Field, Va., and Pratt was Commandant at the School of Aviation Medicine. 



ORIGINS OF AN AIR FORCE MEDICAL SERVICE 



43 



»Ubid. 

AAF Personnel Orders No. 240, 12 Oct 1939. 

Quoted in "Proceedings of the Board of Officers," (n. d.), pp. 1-2. 
118 "Proceedings of the Board of Officers," pp. 5-7, 
114 Ibid., p. 8. 
™lbid., pp. 9-10. 
118 ibid., p. 10. 

117 Ibid., p. 11. 

118 Ibid., pp. 12-13.. 

119 Ibid., pp. 13-14. 

120 First authorized by WD Letter, dated 4 Mar 1942. See also change No. 13, AR 600-35, 1 1 Feb 1943. 

121 Ibid., pp. 19-20. A copy of the "Recommendations" with penciled notations is included in the 
Appendix. 

" a Ibid., pencil notations were made apparently by Col. Eaker relative to action being taken on each 
recommendation as of 17 Jan 1940. 

123 Memo for the Chief of Air Corps, from Gen. F. M. Andrews, 16 Oct 1939, AC/S, G-3. 

124 R&R to Flight Surgeon, OCAC, from the Executive, 24 Oct 1939. 

116 2d ind. (basic Itr., SGO to TAG, 25 May i939)> General Arnold to TAG, 23 June 1939. 
128 Ibid. 

187 Interview, Maj. Gen. Grant by H. A. Coleman, TAS, 20 Jan 1945. 

128 See n. 19 above. 

129 Ltr., Gen. H. H. Arnold to Col. F. L. Pratt, 18 Jan 1939. Col. Pratt conveyed his disappointment 
as to his failure to be appointed Chief, Med. Div. in a letter to General Arnold, 14 Jan 1939. 

""General Grant states that to his knowledge General Arnold was not consulted about his becoming 
a member of the General's staff. Interview 20 Jan 1945. 

131 Interview, Maj. Gen. Grant by Mae M. Link, 27 Oct 1952. 

132 Memo for the Executive, from Chief, Med. Div., 14 Nov 1939. 

133 Memo for Maj. Gen. Arnold from SG, 24 Jan 1940. 

184 Ltr., General Arnold to Lt. Col. A. W. Smith, 29 Jan 1940. 

188 R&R, C/AC to Col. Spaatz, 26 Jan 1940, Comment No. 2, Plans Div. to C/AC, 5 Feb 1940. 

130 Memo for Maj. Gen. James C. Magee from Major General Arnold, 13 Feb 1940. 
187 AR No. 95-5, 20 June 1951. 

™lbid. 
ld9 Ibid. 

140 Ltr., SG to the Chief, AAF, 27 June 1941. 

141 1st ind. (basic ltr., SG to Chief, AAF, 27 June 194O C/AS to the SG, 7 July 1941. 

142 Memo for the C/AC, from Med. Div., 11 July 1941. The memo was written by Col. W. F. Hall 
and concurred in by the Chief of the Med. Div. 

148 Memo for the C/AC from the CG, AAF, 6 Feb 1 942. 

144 R&R, C/AC to Chief, Med. Div., 7 July 1941. 

145 Memo for the Chief, AAF from Chief, Med. Div. (through C/AC) 30 Sept 1941. 

146 WD S. O. No. 254, 3o Oct 1941. 
1#r AAF S. O. No. 51, 30 Oct 1941. 

148 Interview with Col. L. E. Griffis, by H. A. Coleman, 9 Dec 1944. 
148 AAF Reg. No. 25-1, 18 July 1941. 

lw Memo for Chief, AAF, from Col. D. N. W. Grant, TAS, 30 Jan 1942. 

m It should be noted that the functions of the Air Service Division of the SGO were transferred to 
the Chief Surgeon, Air Service, when it was abolished by the SGO in 1919. This organization carried 
on a rather extensive medical service for the Air Service during the war. 

182 Ltr., AAG to C/AC, 6 Feb 1942. 

183 AAF SO No. 42, 18 Feb 1942, relieved the following officers from duty in the OCAC and directed 
them to report to the Chief of the Army Air Forces for duty: Col. David N. W. Grant (MC), Lt. Col. 
George R. Kennebeck (DC), Mai. George L. Ball (MC), Maj. Henry C. Chenault (MC), Maj. John C. 
Flanagan (AC), Maj. Loyd E. Griffis (MC), Maj. John M. Hargreaves (MC), Maj. Edward J. Kendricks 

262297°— 55 5 



44 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



(MC), Capt. Frank Cone (MAC), Capt. Edward L. Gann (MC), Capt. James F. Hoffman (MAC), Capt. 
William A. Moore (MC), Capt. Walter L. Deemer, Jr. (AC), Capt. Dale A. Rice (MC), and Capt. John C. 
Sullivan (MC). 

" 4 This term was changed to "Army Service Forces" in early 1943. 

165 WD Circular No. 59, 2 Mar 1942. 

™Ibid. 

™lbid. 

" 8 Directive from Major General Arnold to Colonel Grant, TAS, 9 Mar 1942. 

Ltr., SG to CG, SOS, 25 Mar 1942. 
"° 2d Ind. (Basic SG to CG, SOS, 25 Mar 1942). 

191 Memo for CG's, AGF, and SOS, WDGCT 020 (4-17-42), 23 Apr 1942. 
""ibid. 

193 In a later directive to Corps Area Commanders the technical inspections mentioned in this paragraph 
were elaborated on further. In making these inspections, the Corps Area Commander was to act as a 
direct representative of The Surgeon General. A copy of each report was to be sent to The Surgeon 
General, "who will report to the Commanding General, Services of Supply, those matters the correction 
of which are necessary and beyond his control." CG, SOS, to all Corps Area Commanders and SG, 
SPOPM 020 — Medical (3-28-42), 26 May 1942. 

194 Ibid. 

165 Memo for Deputy Director of Operations to all Corps Area Commanders and SG, SPOPM 020 — 
Medical (3-28-42), 4 June 1942. 



Chapter II 

THE WAR MISSION 



Throughout World War II there was never a clear-cut policy on the role 
of the medical element of the Army Air Forces. This was due to many compli- 
cating factors. First was the lack of agreement among military leaders them- 
selves as to what constituted the combat mission of the air arm. Air Force 
officers held that the creation of the Army Air Forces in June 1941 recognized in 
principle that the plane had capabilities of its own as a combat weapon; that this 
principle was given substance in the March 1942 reorganization when the fixed 
and mobile elements of the Office of the Chief of Air Corps and the Air Force 
Combat Command were combined into a major force. By official regulation 
the mission of this force was training, as was that of the Army Ground Forces. 
The Army Air Forces was thus an organizational entity composed entirely of 
air commands and units to be trained and used in combat in accordance with 
the broad principles for the application of air units and forces in combat. This 
force was a unified weapons system whose effectiveness was determined by 
such individual components as the plane, the bomb, and the pilot. Since the 
combat mission dictated that the system be constantly in effect, this meant that 
continuous control must be maintained by the major force; and to maintain 
this continuous control the jurisdiction of the major force could not be limited 
by the conventional boundaries of time and space traditionally applied to 
surface armies. Such administrative areas as "Theater of Operations" and "Zone 
of Interior" had little significance to a plane which could traverse the distance 
from one to the other with greater ease than the pace at which foot soldiers 
could travel from one night's bivouac to the next. Moreover, having to main- 
tain continuous readiness, the air weapons system could render obsolete the 
conventional pattern of gradual mobilization and deployment of large land 
armies. This meant that conventional military terminology would have to be 
redefined for the Army Air Forces if its combat mission were accepted as 
that of an air weapons system. 



[45] 



46 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

As World War II approached, however, few ground officers conceded that 
the plane properly belonged within the framework of an air weapons system, 
organizationally identified and directed in combat by an air commander. The 
demonstration of air power in Western Europe made little impact upon tra- 
ditionally-minded line officers. Lt. Gen. Lesley McNair, Commanding General 
of the GHQ Planning Staff and later of the Army Ground Forces, viewed the 
infantry as the backbone of the fighting force and the plane as a special weapon 
to support the ground mission. In the year prior to the March 1942 War 
Department reorganization he had in effect superimposed a theater of opera- 
tions upon the Zone of Interior for training purposes 1 and exercises had been 
based upon this fundamental concept of the plane, like the armored tank, as 
being a special weapon. Thus between June 194 1 and the War Department 
reorganization of March 1942 there was duplication and inevitable confusion 
in training plans and concepts. While reorganization of the War Department 
placed responsibility directly upon the Commanding General, Army Air Forces, 
ground officers steeped in the military tradition of land warfare did not reorient 
their concepts. With a fundamental difference in the concepts of line officers 
toward employment of air power in war, there would obviously be confusion 
and differences in opinion among noncombat planners who had to provide serv- 
ices in the Zone of Interior as well as provide annexes to war and logistical plans. 
Nowhere were the differences more clearly pointed up than in medical plans 
and policies evolved to support the major combat mission. It was to take the 
stress of a major global war, however, to reveal that among medical officers 
as well as line officers there was a fundamentally different concept of the air 
force mission and therefore of the type medical service required in the total 
war machine. 

The flight surgeon had strong convictions about the medical requirements 
of an Air Force in peace and war; his major concern since the first World War 
had been in the field of aviation medicine and more than anyone else he was 
equipped to cope with the unique health problems of the flyer. Since the 
human element was as vital to the success of the combat mission as the struc- 
turally sound plane, he recognized that the health and mental attitude of the 
individual were links through which the air weapons system could be strength- 
ened or crippled. The underlying principle upon which aviation medicine was 
based therefore stressed the individual as the focal point in any military medical 
system designed to provide for care of the flyer. This developed from the con- 
cept that, ideally, field medical service of an Air Force had its point of applica- 
tion in the air or at the flight time. As a matter of course the flyer received 



THE WAR MISSION 



47 



medical care not only at the station hospital nearest his place of duty, but when- 
ever possible at the flight line; in actual flight this care was extended through the 
services of the flight surgeon. 

On the other hand, The Surgeon General, traditionally concerned with the 
professional care and administration of ground forces, viewed medical require- 
ments in the historical pattern. As senior adviser in the War Department on 
the medical aspects of war and logistical planning, he appears never to have 
recognized the combat potential of the plane or the military significance of the 
March 1942 reorganization. Rejecting the basic premise that the Army Air 
Forces had a major combat mission beyond support of the ground forces in a 
conventional theater of operations, he did not therefore accept the corollary 
premise that this combat mission must be independent of the traditional system 
of hospitalization and evacuation which supported land forces. To appreciate 
The Surgeon General's position, it is necessary to understand the traditions 
affecting his policies. In his capacity as Special Staff member, The Surgeon 
General was traditionally responsible for developing the medical elements in 
war plans. Overshadowing this function, however, was the service function 
in the Zone of Interior. The War Department was organized into arms and 
services comprising the various corps. The Medical Corps supported all arms 
and services of the Army in peace and in war. In peacetime the Medical De- 
partment, established by Act of Congress, functioned with considerable 
autonomy in matters relating to the Army. The Surgeon General enjoyed 
the status of a Special Staff officer in the War Department and at the same time 
operated a hospital system in the Zone of Interior which included (with certain 
exceptions) general and station hospitals. 2 Whereas in the Army Air Forces 
the focal point was the flyer, the center of gravity in the Army medical system 
was the general hospital with its staff of specialists in the Zone of Interior. 
Through a vast and complicated wartime administrative system, the sick and 
wounded were moved from the combat zone to the rear and thence to the Zone 
of Interior where, if necessary, they were sent to general hospitals for definitive 
care. This system had proved effective in previous wars. 

Thus the fundamental differences among line officers as to the Air Force 
mission were reflected in the professional aspects of military medicine and medi- 
cal administration. Medical planners alike were members of the Army Medical 
Corps as contrasted with line officers of the Air Corps; but traditionally "Medical 
Corps" was equatable with ground medical doctrine, and it was apparent that 
there must now be a dichotomy in the application of the principles of military 
medicine as aviation medicine became the "field medicine" of the Air Force. 



48 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

Finally, any discussion of the wartime medical program must reflect the 
status of The Surgeon General in relation to the total War Department organi- 
zational structure as well as the scope of his responsibilities in determining 
global medical policies. Had he perceived the full significance of the wartime 
reorganization, he possibly would not have tried to retain both staff and opera- 
tional functions within his office. Since he did not make himself felt when the 
War Department organizational planners were evolving the March 1942 system, 
no provisions were made for a senior medical staff officer to serve at the War 
Department General Staff level as coordinator of the medical activities for the 
three major forces. Because he controlled the general hospital system, The 
Surgeon General was placed with the other technical services at a relatively 
low echelon under the major noncombat force, The Services of Supply (SOS), 
later designated the Army Service Forces. The merits of organizing the non- 
combat elements into a major service force are debatable. In World War II 
when this was done the major goal was production. Thus, the major emphasis 
was upon commodities, subject to the techniques of mass production. There is 
also some question as to whether a service such as that provided by the Office 
of The Surgeon General, which was concerned with the health and welfare of 
the fighting forces, properly belonged with the supply agency. Nevertheless, 
because he had not initially established his position clearly as senior medical 
adviser to the Chief of Staff, The Surgeon General found himself under the 
command of the Commanding General, Army Service Forces. He was thus 
limited in his access either to the Chief of Staff or to the Commanding Generals 
of the Army Ground Forces and the Army Air Forces. Under these circum- 
stances, the medical service element could become isolated from the milieu of 
day-to-day thinking from which tactical planning was evolved. Since The 
Surgeon General was not an active senior medical adviser to the Chief of Staff, 
he could not so well keep abreast of top-level planning. Nor could he plan or 
recommend in terms of strategic thinking since his superior, The Commanding 
General, Army Service Forces, was not a member of the Joint Chiefs of Staff. 
But General Arnold, a member of the Joint Chiefs of Staff, was able to consider 
his medical requirements in terms of the strategic mission. His senior medical 
adviser was therefore in a position to press for a dynamic medical program to 
meet the combat requirements of the Army Air Forces. 

These factors must all be kept in mind as contributing to the sequence of 
events during the war which led to policy decisions, their modifications and 
sometimes their reversals. In summary, there were three problems: the 
reluctance of traditionally minded line and staff officers to recognize the plane 
as a part of an air weapons system rather than a special weapon to support 



THE WAR MISSION 



49 



the ground mission; the basic issue of whether the Army general hospital or 
the individual aircrew member should be the vital center of the air force medical 
support system; and the military principle involved in wartime control of a 
major combat force medical service by a noncombat force commander. Tradi- 
tion was on the side of The Surgeon General, who continued to view himself 
as the senior medical officer of the Army and, as such, responsible for the health 
of all die Army, including the Army Air Forces. Conditions favored the 
Air Surgeon. 

The two medical officers who defended these principles were both highly 
regarded in the medical profession. Maj. Gen. David N. W. Grant, the Air 
Surgeon, had been a career officer since 1916 and was a graduate of The Army 
Medical School, The Air Force Tactical School, The Chemical Warfare School 
and the School of Aviation Medicine. He was recognized as an able admin- 
istrator as well as an outstanding obstetrician. General Arnold was to place 
increasing trust in his judgment, as indicated by the support he gave to his recom- 
mendations. In the Army, General Magee, The Surgeon General, was to 
retire before the war had gotten into full swing. Maj. Gen. Norman Kirk, 
who became The Surgeon General in May 1943, was to be the principal exponent 
of the Army viewpoint. An outstanding orthopedic surgeon, General Kirk 
was a strong defender of the general hospital system. As the war progressed, 
these two officers came to symbolize two schools of thought. Their common 
goal as medical officers was, of course, identical: to preserve the optimum 
health of the fighting forces. As members of the medical profession, both 
officers alike desired that the fighting forces be provided the best possible 
professional care. The differences therefore were primarily in terms of military 
doctrine, placement of functional responsibilities and of method rather than 
of objective* Sometimes, however, this fact became obscured in the day-to-day 
struggle to maintain the health of the newly mobilized forces and to provide 
for their care as they were dispersed to all areas of the globe. One manifesta- 
tion of this fundamental and irreconciliable difference was in the inevitable 
personality clashes between the two major protagonists, General Kirk and 
General Grant. Another manifestation was the partisan loyalty of their 
respective staffs. In The Surgeon General's Office the specialists, not necessarily 
geared to military procedures in wartime, apparently believed that their pro- 
fessional judgment was being questioned when they were called upon to justify 
a position. In the perhaps over-sensitive Air Surgeon's Office, on the other 
hand, every restrictive action of The Surgeon General was usually interpreted 
as a direct blow at the Army Air Forces. It was fortunate indeed that Brig. 
Gen. Raymond W. Bliss, Chief of Operations and later Deputy Surgeon 



50 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

General, recognized the very real problem of the Air Surgeon as well as those 
of The Surgeon General and was able to serve as a moderating influence at 
times when in the heat of the moment the fundamental issues at stake might 
have been forgotten. 3 His able assistant in these matters was Col. Albert H. 
Schwichtenberg the flight surgeon assigned by the Air Surgeon to the Office 
of The Surgeon General as air liaison officer. 

The Issues Emerge: 1942. 

Since the Army and the Army Air Forces could not reach a common ground 
in determining the basic air force mission, it is debatable whether medical 
planners under any circumstances could have agreed on a unified medical service 
to meet wartime requirements. General Grant, the Air Surgeon, had been 
initially hopeful as demonstrated by his attitude toward The Surgeon General's 
Office prior to the war period. During the months preceding the war he had 
viewed The Surgeon General as his superior, but at the same time recognized 
that The Surgeon General's Office did not take seriously his recommendations 
for the air force medical program. 

This fact was brought home with force in 194 1 when he returned from 
England where he had served as a medical observer. Upon his return he pre- 
pared a plan whereby the sick and wounded could be evacuated by air. The 
plan was transmitted to The Surgeon General for approval or comment, but was 
pigeonholed without action. After nearly 9 months of waiting the Air Surgeon 
by-passed The Surgeon General and went to the War Department General Staff 
with a carbon copy of the plan. On the following day General Magee, The 
Surgeon General, went to General Arnold's office where he demanded that 
disciplinary action be taken because the Air Surgeon had by-passed proper 
channels. General Arnold brought the two medical officers together and 
stated his position in the matter. In the future the Air Surgeon was to be 
directly responsible to him and not to The Surgeon General. 

The clarification of General Arnold's position represented a major mile- 
stone since prior to this time there had been some uncertainty as to how Air 
Force line officers reacted to the service element. From this time forward, 
however, the Air Surgeon was to enjoy a position in relation to his Command- 
ing General that The Surgeon General was never able to attain with his Com- 
manding General. 

The first tangible step in establishing a wartime medical service to meet 
Air Force needs was taken in the spring of 1942 when the Army Air Forces 
established its own procurement system to obtain medical officers. The expan- 



THE WAR MISSION 



51 



sion program of the Air Corps prior to the entry of the United States into 
World War II had created an immediate demand for Medical Corps officers. 
This requirement was greatly accentuated after the entry of the United States 
into the war. The established procedures for producing doctors by the Office of 
The Surgeon General and allotting a quota to the Air Forces failed to provide 
the necessary medical officers to meet the situation. This was admitted by The 
Surgeon General when he advised the Secretary of the General Staff of the 
War Department that it had been impossible to fill the 1,500 places allotted 
for Medical Corps officers prior to the war. 4 

The Medical Department of the Army had turned first to the American 
Medical Association for aid in recruiting doctors. This agency was asked to 
prepare and maintain a roster of civilian physicians, properly classified as to 
specialties and proficiency, who would be willing to accept commissions in the 
Army when needed. The Surgeon General would place one or more rep- 
resentatives of his office on duty at Headquarters, VI Corps Area, to imple- 
ment the program. Should there be no Reserve officer available for a vacancy 
in allotments for a corps area, The Surgeon General would notify his repre- 
sentative at VI Corps Area Headquarters, who in turn would request recom- 
mendation from the American Medical Association for a civilian doctor to be 
commissioned for the vacancy. The Corps Area Commander was responsible 
for having the candidate examined and securing from him a completed applica- 
tion for commission. All papers were then sent to The Adjutant General for 
final action. 5 

To insure that the limited supply of doctors be given equitable distribution 
among both Army and civilian agencies, a central agency for procurement was 
projected. The initial step in this direction was taken by the Subcommittee on 
Education of the Health and Medical Committee in the Office of Defense, 
Health and Welfare Services, which recommended on 31 March 1941 that such 
an agency be established. 6 This recommendation was transmitted to the Com- 
mittee on Medical Preparedness of the American Medical Association which, 
in turn, presented it to the House of Delegates of the American Medical Asso- 
ciation. The House of Delegates recommended "the establishment of a central 
authority with representatives of the civilian medical profession to be known 
as the Procurement and Assignment Agency for the Army, Navy and Public 
Health Service and the civilian and industrial needs of the nation." 7 

A commission appointed by the Health and Medical Committee drafted 
a plan for this service which was incorporated in a letter written by Paul V. 
McNutt to the President on 30 October 1941 and approved by the President on 
the same date. The new office was to be known as the Procurement and As- 



52 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



signment Agency. Consisting of five board members, the agency was assigned 
the following responsibilities: 8 

(i) to receive from various governmental and other agencies requests for medical, dental 
and veterinary personnel, (2) to secure and maintain lists of professional personnel available, 
showing detailed qualifications of such personnel, and (3) to utilize all suitable means to 
stimulate voluntary enrollment, having due regard for the overall public health needs of the 
nation, including those of governmental agencies and civilian institutions. 

In the organization of the Procurement and Assignment Service, provision 
was made for the location of the central office in Washington, D. C. There were 
liaison, consultant, and advisory committees, and also corps area, state and 
local committees. The facilities of the National Roster of Scientific and Spe- 
cialized Personnel, covering more than 50 strategic scientific and professional 
fields, together with records of the American Medical Association, the American 
Dental Association, and the American Veterinary Medical Association, were 
made available to the Procurement and Assignment Service. In this recruiting 
system, applicants qualified for appointment were supplied the necessary appli- 
cation blanks by the Service and directed to report to the surgeon of the nearest 
Army post for a physical examination. The physical examination report was 
sent direct to The Surgeon General, while all other papers were sent to the 
Procurement and Assignment Service. The Procurement and Assignment 
Service would transmit to The Surgeon General the completed application with 
supporting documents, together with a statement concerning the eligibility of 
the applicant for a commission, and an evaluation of his professional rating as 
determined by the survey made by the Committee on Medical Preparedness of 
the American Medical Association. After the papers of the applicant were 
reviewed by The Surgeon General, they were then sent to The Adjutant General 
with the recommendation of The Surgeon General. The Adjutant General 
was instructed to notify the applicant directly when the appointment was 
approved. 9 

The foregoing lengthy description of the methods of recruitment of medical 
officers is given because it was upon the results of this program that the Army 
Air Forces was dependent for its allotment of Medical Corps officers. It was 
generally agreed that the program was failing to supply the acute demand 
for Medical Corps officers and the Air Surgeon referred to the procure- 
ment for the Army Air Forces prior to April 1942 as "just a dribble." 10 To 
meet the critical situation Col. W. F. Hall, Assistant Air Surgeon, conceived 
a plan to aid in recruiting doctors which had as its ultimate goal the procure- 
ment of the necessary doctors urgently needed for the Army Air Forces. This 
plan was in the nature of an informal agreement with The Surgeon General, 



THE WAR MISSION 



53 



G-i, and the Procurement and Assignment Service whereby the Air Surgeon's 
Office would coordinate and process for The Surgeon General all papers of 
applicants who expressed a desire for service with the Air Forces. 11 This was 
not an actual "procurement" program, inasmuch as all papers, including the 
physical examination, had to be passed on by The Surgeon General; but it was 
believed that the plan would accelerate the recruiting process and give the Army 
Air Forces a claim on the men whose papers were processed by the Air 
Surgeon's Office. 12 

Colonel Hall outlined the details of the plan to be followed in a letter to the 
Air Surgeon 2 April 1942. 13 It was to be implemented by ( 1) publicity through 
the Journal of the American Medical Association and press releases; (2) in- 
structing officers on duty with the Air Forces to send in lists of names of desirable 
prospects, helping them complete the necessary forms, and directing them to 
stations where the physical examination could be made; and (3) the prepara- 
tion of explanatory packets to be sent each prospective applicant. These packets 
included a letter describing the opportunities for service with the Army Air 
Forces and authorizing a physical examination, together with a list of Army 
Stations where examinations could be made, and a complete set of application 
blanks. 14 Applicants were advised to send all papers, including report of 
physical examination, direct to the Office of the Air Surgeon. 15 

This method of recruiting doctors presented an innovation, the psychologi- 
cal aspects of which pointed toward success. The prospective candidate was 
promised insofar as possible that his preference for service in certain sections 
of the country 16 would be considered and that his assignment to duty would 
be in accord with his specialty. Personal letters were sent to applicants explain- 
ing the appointment procedure and answering questions asked by them. In 
addition, Medical Corps officers on duty with the Army Air Forces rendered 
a personalized service in persuading applicants of the attractiveness of service 
with the Army Air Forces and in actually helping to fill out the necessary 
forms. It is probable that these representatives of the Air Surgeon were some- 
times overly enthusiastic, 17 but they were given strong support from Head- 
quarters in the work for which they were detailed; 18 and the program, as 
conceived and put into operation, proved successful in attracting many doctors 
who eventually were commissioned and assigned to duty with the Army Air 
Forces. 

Meanwhile, the procurement objective established as of 2 April 1942 was 
2,200 Medical Corps officers between 1 April and 1 July 1942 and 500 per month 
for the remainder of the year. To meet that objective the Director of Military 
Personnel, Services of Supply, 19 in a memorandum to The Surgeon General 



54 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



dated 12 April 1942 directed that plans be made for the immediate decentraliza- 
tion of the procurement of doctors to representatives of The Surgeon General 
in the forty-eight states. It was suggested that the plan be liberalized in order 
that the shortage of five thousand doctors be overcome immediately. With this 
objective in mind, it was recommended that grades be offered which would 
attract qualified applicants, that age limits be removed in order that experienced 
men be recruited, and that graduates of accredited medical schools who were 
licensed by a state be eligible for commissions. This plan was to be imple- 
mented by the active aid of Corps Area and Station Surgeons and by an 
intensive publicity campaign through press and radio. The plan was sub- 
mitted to G-i by the Director of Military Personnel 20 on 22 April 1942, 
approved by G-i on the same date, and published as an Adjutant General's 
Letter dated 25 April 1942. 21 On the authority of this letter the War Depart- 
ment issued a directive to the Commanding General of each Corps Area to 
appoint a Medical Officer Recruiting Board for each state within his jurisdic- 
tion. 22 Each board would consist of one Medical Corps officer and one other 
officer. 23 These boards were authorized to process papers of applicants and 
make appointments in company grades for those under 45 years of age, with 
papers of applicants for field grade sent to The Surgeon General. 

The Air Surgeon gave some indication of the success of the recruiting 
activities of his office as of 19 May 1942. 24 At this time over four thousand 
doctors had been contacted and papers for 726 applicants had been completed 
and forwarded to The Surgeon General. This was netting from 30 to 40 
doctors a day for service with the Air Forces. Yet, in the same memorandum 
of 19 May 1942, the Air Surgeon referred to a "bottleneck" in the recruiting 
program in these words: ". . . we cannot deal directly with The Adjutant 
General, cannot pass on the physical examinations, we have no authority in 
procuring, and all papers go to The Surgeon General who makes the final 
decision as to grade and recommendation to the Appointment Section of The 
Adjutant General's Office." 25 

Immediate efforts were directed toward the elimination of this bottleneck 
in the recruiting procedure. Col. Edward S. Greenbaum, Executive Assistant 
to the Under Secretary of War, became interested in the problem and discussed 
it with the Air Surgeon and the Assistant Secretary of War for Air. 26 

A memorandum incorporating the problem described by the Air Surgeon 
was transmitted to The Surgeon General for comment. Brig. Gen. C. C. Hill- 
man answered it in the form of a memorandum to Colonel Greenbaum, dated 
3 June 1942, 27 in which he stated that the exigencies of the situation did not 
justify a change in recruiting procedures. He stated, however, that there was 



THE WAR MISSION 



55 



no objection to delegating to the Commanding General, AAF, the authority to 
pass on reports of physical examinations and grant waivers for the assignment 
of Reserve officers on the active list excepting in the case of officers in the inactive 
Reserve. The right to pass on the physical qualifications of all applicants for 
commissions, including the granting of waivers in ordinary cases, was con- 
sidered a prerogative of The Surgeon General, although in unusual cases waivers 
could be granted by the Secretary of War. It was noted that after an individual 
was accepted for service, it was the responsibility of the Air Surgeon to 
determine physical qualifications for flying, including the granting of waivers. 

The Military Personnel Division, Services of Supply, recognizing the 
urgency of the Air Surgeon's position, made recommendations to the Assistant 
Chief of Staff, G-i, 28 which substantially incorporated The Surgeon General's 
recommendations. The plan provided for the processing of applications 
through the Appointment and Procurement Section, A-i, Army Air Forces. 
A representative of The Surgeon General was detailed for duty in A-i for 
consultation pertaining to physical examinations. Disagreements would be 
appealed to the War Department. Papers would be processed, letters of appoint- 
ment issued, and completed papers sent to The Adjutant General, with requests 
for orders, except appointments in field grade, which would be sent to The 
Surgeon General. It was recommended, finally, that the "authority for the 
granting of waivers for flying duty for individuals who have satisfied the 
standards established by The Surgeon General for appointment in the Army of 
the United States, be delegated to the Commanding General, Army Air Forces, 
upon recommendation of the Air Surgeon." 29 

The recommendations of the Military Personnel Division, Services of 
Supply, 30 were approved by the War Department, and as a result, the Army 
Air Forces was authorized to recruit directly Medical Corps officers in company 
grades. It appears, however, that this authority was never used 31 because The 
Surgeon General still remained responsible for the procurement objectives of 
the entire War Department. The office of the Air Surgeon, however, con- 
tinued its publicity campaign to interest civilian doctors in accepting service 
with the AAF, received and processed their papers, recommended grades, and 
sent completed papers to The Adjutant General for commissioning. The 
physical examinations were passed on by representatives of The Surgeon 
General who were attached to the Office of The Adjutant General. 

This arrangement satisfied the Air Surgeon in that it provided a means of 
selection, which was considered as important as the quantity of doctors procured; 
furthermore, it satisfied The Surgeon General who continued to control the 



56 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

procurement objective of doctors for the Army as well as all appointments in 
field grades. 

In summary, the fundamental reasons motivating the movement for a 
separate procurement program for the Army Air Forces had been: (i) the 
failure of the usual recruiting agency to provide the necessary number of 
Medical Corps officers for the expanding air arm; (2) the failure to provide 
the necessary specialties; and (3) the practice of screening the best men and 
making assignments to the Air Forces from the residue. 32 With basic plans 
for overcoming these problems the Air Surgeon and The Surgeon General 
could work jointly toward achieving a common goal. New impetus was given 
to the recruiting program. Some measure of the success of these recruiting 
efforts should be indicated, insofar as they concern the Air Forces. A report 
of the Procurement and Assignment Section, Personnel Division, Office of the 
Air Surgeon, for the period from 21 March 1942 to 1 July 1942 follows: 33 



Complete packets sent 4, 083 

AC, 6565 Questionnaires sent 876 

Applicants disqualified 280 

Applicants rejected 486 

Applicants not desiring Air Forces 155 

Orders requested for extended active duty with Air Forces 2, 053 



It can be seen from these data that the number of doctors recruited approximated 
the objective of 2,200 previously set for this period. The next recruiting period, 
1 July 1942 to 1 December 1942, was equally as successful as the first one. 



Table i. — Procurement of Medical Corps Officers for Duty With the Army Air 
Forces from August 1942 to 1 December 1942 



Month 


TAS through 
A-l* 


MORB 


TAS 
through 
SGO 


MORB 
through 
SGO 


Total 


Physi- 
cally 
disqual- 
ified** 


Rejected 
by 
TAS 


Capt. 


1st Lt. 


Capt. 


1st Lt. 


Major 


J^y 


163 
124 
242 
91 


224 
205 
263 
102 


Not av 
190 
188 
53 


ailable 
363 
321 
193 
78 


64 
23 
21 


353 
27 
22 


1, 266 
1, 357 
888 
794 
271 


101 
543 
146 
133 
61 




August 


23 
71 
67 
31 


Total 








620 


794 


431 


955 


108 


402 


4,576 


984 


192 



*Desienated Military Personnel in October 1942. 

"Includes only applicants whose papers were processed through The Air Surgeon's Office. 
Data taken from records of Personnel Division, AFT AS. 



THE WAR MISSION 



57 



Table i shows the number of Medical Corps officers procured through the 
various recruiting agencies for this period. Since the allotted quota of medical 
officers had been reached in all but a few states by the fall of 1942, the medical 
officer recruiting boards were discontinued in all states except California, Illinois, 
Pennsylvania, New York, and Massachusetts. 34 It was announced on 31 October 
1942 that officer procurement branches had been established within the service 
commands and were ready to procure officers for all agencies of the Services of 
Supply. 35 Chiefs of supply services were directed to advise all field agencies to 
discontinue procurement activities, although exception was made in the case of 
The Surgeon General, who was authorized to continue his procurement 
activities. 

A plan of the Services of Supply to centralize all procurement agencies 
under one head was published as War Department Circular No. 367 dated 
November 1942. This circular established the Officer Procurement Service 
under the Chief of the Administrative Services, Services of Supply, which 
agency was authorized to deal directly "with the Commanding Generals, Army 
Ground Forces and Army Air Forces, and chiefs of supply and administrative 
services and with the Secretary of War's Personnel Board in matters pertaining 
to the procurement and appointment of officers." 36 Exception was made for 
"those agencies granted authority by the War Department to appoint officers 
without reference to the War Department." 37 

On 1 December 1942 The Surgeon General and the Air Surgeon were 
directed to forward all requests for appointment of doctors, dentists, and veteri- 
narians to the Officer Procurement Service, which would submit them to the 
Secretary of War's Personnel Board. 38 Authority of Corps Area Commanders 
and field representatives of The Surgeon General to make appointments to the 
Medical Corps was discontinued. 39 

The Chief, Field Operations Branch, Officer Procurement Service, stated 
on 13 January 1943 that The Surgeon General had asked the Officer Procure- 
ment Service to assume responsibility for the processing of papers of doctors, 
dentists, and veterinarians. 40 The new procedure as announced was simple. 41 
The State Chairman for doctors, dentists, and veterinarians (War Man Power 
Commission) would certify the candidate to the district officer of the Officer 
Procurement Service, who would complete the necessary papers, order a physical 
examination, and send all papers to The Surgeon General. If the applicant pre- 
ferred duty with the Army Air Forces, this preference should be plainly indi- 
cated by the State Chairman on the "Availability Clearance Form." Recruiting 
in accordance with this plan was scheduled to begin on 15 January 1943 in the 



58 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



States of California, Colorado, Connecticut, Illinois, Iowa, Maryland, Massa- 
chusetts, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, 
New York, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Wisconsin, 
and in the District of Columbia. 42 The Adjutant General, in a memorandum 
of 22 February 1943, 43 declared the Office Procurement Service the sole agency 
for the procurement from civil life of officers for the Army. Other War Depart- 
ment agencies were directed to cease recruiting activities. Further, all Person- 
nel Placement Questionnaires in the offices of any War Department agency, 
upon which no action would be taken by 1 March 1943, should be forwarded 
to the Officer Procurement Service. This memorandum made it necessary for 
the Air Surgeon's Office to transmit approximately 300 applications to the 
Officer Procurement Service 44 which in turn distributed them to the appropriate 
district offices with instructions for completing them. 

Procurement data for the third period, 1 December 1942 through December 
1943, are given in Table 2. A recapitulation of Medical Corps procurement 
statistics for the 2-year period follows: 45 

1. Number of Medical Corps officers on hand at the time of Pearl Harbor 

approximately 800 

2. Number procured during period from 21 March 1942 to 1 July 1942 2, 053 

3. Number procured during the period from 1 July 1942 to 1 December 1942 4, 576 

4. Number procured during the period from 1 December 1942 to 1 January 

1944 i, 102 

5. Internes assigned during the period from 1 July 1943 to 1 November 1943 402 

8, 933 

As the statistics indicate, the procurement program of the Air Surgeon's Office 
was highly successful. Not only did it result in securing the services of a 
great many doctors for duty with the Army Air Forces, but it also provided a 
means of selecting candidates according to ability and specialty. 

All officers in the Dental Corps, Veterinary Corps, Sanitary Corps, and 
Medical Administrative Corps were procured by agencies other than the Office 
of the Air Surgeon and were assigned by The Surgeon General to duty with the 
Army Air Forces. Applications for appointment in these corps received by the 
Office of the Air Surgeon were transmitted to the proper recruiting agency. 

The procurement program to obtain Army Air Forces' nurses followed 
a course somewhat similar to that for medical officers. The movement to 
establish a Nursing Division in the Air Surgeon's Office was agreed to by 



THE WAR MISSION 



59 



Table 2. — Procurement of Medical Corps Officers for Duty With the Army Air 
Forces from 1 December 1942 Through December 1943* 



Month 



December . 
January . . . 
February . . 
March .... 

April 

May 

June 

July 

August. . . 
September . 
October. . . 
November . 
December . 



Total . 



OPS 



Capr. 



61 
29 
19 
7 
5 
7 
1 

11 
10 
11 
12 
2 



175 



1st Lt. 



71 
71 
28 
53 
59 
102 
25 
173 
109 
90 
58 
7 
3 



849 



MORB 



Capt. 



1st Lt. 



50 
6 



56 



SGO 



Major 



11 



32 



Total 



185 
113 
53 
63 
66 
109 
26 
184 
119 
102 
70 
9 
3 



1, 102 



Physi- 
cally 
dis- 
qualified 



44 
30 
15 
15 

38 
41 
38 
58 
13 
34 
21 
7 



354 



Rejected 
byTAS 



21 
20 
24 
10 
5 
5 
19 



104 



*The Surgeon General stopped forwarding applications of doctors desiring duty with the Army Air 
Forces on 30 October 1943- Cases processed since this date were in the Air Surgeon's Files. Data taken 
from records in Personnel Division, AFTAS. 

Col Julia C. Flikke, Superintendent of Nurses, Office of The Surgeon General, 
in a conference with the Air Surgeon on 22 September 1942. 46 At this meet- 
ing it was agreed that: (1) nursing personnel on duty with the Army Air 
Forces would be under the direct control of the Commanding General, Army 
Air Forces, on the same basis as other medical personnel: (2) the Nursing 
Division would supervise nurses on duty with the Army Air Forces; (3) the 
Army Air Forces would initiate a nurse procurement program; (4) nurses on 
duty with the Army Air Forces would not be removed without approval by the 
Army Air Forces; (5) a definite allotment of nurses would be made; (6) Army 
Air Forces would assume responsibility for the nursing service within Army 
Air Forces installations; and (7) a minimum of two nurses would be assigned 
by the Superintendent of Army Nurses for duty in the Office of the Air Surgeon. 
This agreement was subsequently approved by The Surgeon General and became 
the basis of operations for the Nursing Section established in the Office of the 
Air Surgeon. 47 

262297°— 55 6 



60 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



In a directive to The Adjutant General dated 3 December 1942, The Surgeon 
General authorized the Commanding General, Army Air Forces, to procure and 
appoint Reserve nurses, assign and transfer them, and discharge them "for 
unsuitability and conduct prejudicial to the service." 48 The Adjutant General 
officially notified the Commanding General, Army Air Forces, 18 December 
1942, in this language: "Authority is granted, effective immediately, to procure 
and appoint Reserve nurses of the Army Nurse Corps, to assign them to stations 
under your jurisdiction, and to transfer them from one station to another within 
your command." 49 

In the meantime, Capt. Nellie V. Close, Army Nurse Corps, reported for 
duty in the Office of the Air Surgeon, 4 November 1942. 50 Prior to the 
issuance of The Adjutant General's letter of 18 December 1942 granting pro- 
curement authority, the Nursing Section completed no applications and sent 
them to the Office of The Surgeon General for appointment and assignment 
to duty with the Army Air Forces. 51 

Because of the lack of personnel in the Nursing Section to handle success- 
fully the recruiting program, this function was delegated to the Procurement 
Branch of the Personnel Division. 52 This agency directed publicity, forwarded 
application packets, and carried on the necessary correspondence with the 
applicants. The Procurement Branch began the actual processing of applica- 
tions from nurses during the latter part of February 1943. During the period 
from February 1943 to 1 March 1944, a tota ^ °^ 4> I 5 2 applications was completed 
and transmitted to the Nursing Section for appointment and assignment. 53 

Table 3 shows the monthly assignments of nurses by the Nursing Section 
during the recruiting period. 54 

Table 3. — Nurses Assigned by the Nursing Section, Office of the Air Surgeon 

1943 — January 69 1943 — October. . . .- 288 

February 98 November 271 

March 181 December 113 

April 259 1944 — January 234 

May 404 February . . . . 302 

June 396 March 261 



July 333 

August 245 Total 3, 742 

September 288 



THE WAR MISSION 



61 



Estimated data concerning the appointment, assignment, and transfer of nurses 



appear below: 

Number of nurses procured from SGO i, 625 

Number of nurses procured from 1 January 1943 to 1 March 1944 by the Office of 

the Air Surgeon 3, 742 

Number of nurses procured by other agencies from 1 January 1943 to 10 May 1944 

and assigned to duty with the Army Air Forces 3, 357 



Total procurement 8, 724 

Number of nurses transferred to Army Service Forces and Army Ground Forces from 

18 December 1942 to 1 January 1945 3^489 

Nurses on duty in the Zone of Interior as of 1 December 1945 3, 461 



Another category of personnel for which a speGial procurement program 
was established was hospital dietitians and physical therapy aids. 

In December 1942 Congress made provision for the militarization of female 
hospital dietitians and physical therapy aides. They were to be appointed as 
officers in the Medical Department with relative rank, pay, and allowances for 
commissioned officers, without dependents, of the Regular Army. As a result 
of this legislation, members of these specialties were entitled to the same re- 
muneration, rights, and privileges as members of the Army Nurse Corps. 5 " 

There was an urgent need for these specialists for duty with Army Air 
Forces medical installations. The situation with respect to hospital dietitians 
had become acute because civilian appointments were to be terminated as of 
31 March 1943 and many of these civilians were ineligible for appointment 
in the Army. In order to meet the need for both hospital dietitians and physical 
therapy aides the Office of the Air Surgeon initiated a procurement program 
in April 1943. 56 Necessary arrangements were made with the Director of Dieti- 
tians, Office of The Surgeon General. Publicity was prepared, many of the larger 
hospitals which gave courses in dietetics were circularized, and a representative 57 
of the Air Surgeon visited many of the midwestern hospitals, explained the needs 
of the Army Air Forces for hospital dietitians, and personally soliciated civilians 
in training in these institutions for appointments and assignment to duty with 
the Army Air Forces. Approximately the same type of procedure was followed 
in connection with the efforts to recruit physical therapy aides. The support of 
the President of the American Physiotherapy Association was enlisted, 58 an 
informative article submitted to the Physiotherapy Review for publication, 59 and 
about 1,500 individual letters sent to the members of the American Physiotherapy 
Association. 60 

The Officer Procurement Service agreed to be responsible for recruit- 
ing these specialists for all components of the Army. Each candidate was 



62 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



permitted to indicate her choice of service with the Army Air Forces, Army 
Ground Forces, or Army Service Forces; and in keeping with her qualifications 
and the needs of the service, the choice would receive consideration. 61 The 
agreement provided for an allotment of approximately 25 percent of the recruits 
for duty with the Army Air Forces. 62 As a result of this agreement, the Air 
Surgeon ceased his procurement activities in this area and all applications on 
hand were transmitted to the proper agency for processing and appointment, 
with the request that personnel so appointed be assigned to duty with the 
Army Air Forces. 

Aviation physiologists constituted another category of personnel needed by 
the Army Air Forces, especially after the establishment of the high-altitude 
indoctrination program, 63 and it was necessary to procure officers to staff the 
various units. It was decided by the staff of the Air Surgeon's Office that the 
educational requirement for this work should be that the candidate hold the 
degree of doctor of philosophy in the biological sciences from an accredited 
institution, or equivalent training, witft emphasis on human physiology. 64 
Later an additional provision stated that the degree must be received within 
three years of the request for appointment. 65 

The high-altitude indoctrination and classification program for aircrew 
personnel was intended to familiarize them with the "physiological principles 
of high-altitude operations and to classify flying personnel as to tolerance to 
anoxia, decompression sickness, and other conditions incident to high-altitude 
flights." 68 This objective would be accomplished by lectures on the physiology 
of flight, demonstrations of the use of oxygen equipment, and simulated flights 
in low-pressure chambers. Since it was necessary for these officers to be subjected 
to repeated simulated high-altitude flights in the low-pressure chambers, it was 
imperative that they be young men, for it was generally agreed that young men 
could better withstand the rigors of this exposure than could older personnel. 67 
It was thus correctly anticipated that the procurement of officers who could 
qualify as aviation physiologist would be extremely difficult, for the age and 
educational requirements would indicate a scarce skill. 

In a prepared letter for G-i, dated 2 February 1942, the Air Surgeon 
requested that an additional allotment of 150 officers be made to the Air 
Forces for aviation physiologists, and that in commissioning these officers the 
present policy on age be waived for the lieutenants. 68 These officers would 
include grades from lieutenant colonel to second lieutenant. Apparently this 
letter was either not sent by the Chief of the Air Staff, or was not complied with, 
for on 11 June 1942, a request was made to A-i, Appointment and Procurement 



THE WAR MISSION 



63 



Section, for a like number of physiologists to be commissioned as first and second 
lieutenants, 69 the names of the prospective candidates to be furnished by the 
Air Surgeon's Office. 70 

By 9 September 1942 only 40 physiologists had been commissioned, and a 
request was made at this time for a procurement objective of 100 additional 
officers of this specialty. 71 Because of the large number of flying personnel 
who had to be trained in altitude flights, there was an urgent need for these 
officers. Since officers with the qualifications necessary for aviation physiol- 
ogists were not available, they must now be procured from civil life. In the 
procurement objective for the Army Air Forces dated 28 September 1942, 
therefore, physiologists were listed as one of the categories which could be 
procured from civil life, provided applicants were above 30 years of age 
and not classified by Selective Service as 1-A. 7 " However, both of the latter 
restrictions could be waived if it was shown that the applicant had extraordinary 
qualifications and that the need for his service was critical. 73 This policy 
remained in effect for a year until October 1943, when the Secretary of War 
directed that all procurement objectives for the appointment of officers from civil 
life be canceled with the exception of those for physicians, dentists, chaplains, 
and service pilots. 74 Therefore, this directive canceled the procurement objec- 
tives for aviation physiologists and the Assistant Chief of Air Staff, Personnel, 



advised the Office of the Air Surgeon to this effect. 75 
A recapitulation of procurement data follows: 76 

Number procured through the efforts of the Office of the Air Surgeon 1942 58 

1 January 1943 to 13 October 1943 (date of cancellation of procurement objective) . 54 

After 13 October 1943 4 

Officers transferred to program 19 

Enlisted men commissioned 21 



Total 156 



Number of Medical Corps officers trained as aviation physiologists and at one time 

assigned to the program 77 87 



Although the procurement objective for aviation physiologists was never real- 
ized, it was ultimately possible to relieve all of the Medical Corps officers who 
were assigned to the Altitude Training Units. 78 

Mention must also be made of the efforts late in the war to procure physical 
reconditioning officers. 

In March 1944 a conference was held between representatives of the Office 
of The Surgeon General and the Office of the Air Surgeon 79 concerning the 



64 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



appointment of physical reconditioning officers for the Medical Department 
of the Army. As a result of this conference, Maj. C. G. Munns of the Air 
Surgeon's Office sent a letter 80 to The Surgeon General suggesting that these 
individuals have officer status in order to function efficiently, that many well 
qualified personnel were available from enlisted men, that physical fitness 
officers were not capable of functioning as vocational and educational guid- 
ance officers, that the Army Air Forces needed twenty of these officers, and 
that the Office of The Surgeon General and the Office of the Air Surgeon 
should cooperate in getting a procurement objective for these officers approved. 
Maj. Gen. G. F. Lull, Deputy Surgeon General, prepared a memorandum 81 
for G-i which followed closely the ideas contained in the letter from the Office 
of the Air Surgeon, and Military Personnel Division, Army Service Forces, 
approved the request with the recommendation that appointments, insofar as 
practicable, be limited to individuals already in the service. 82 Upon G-i 
approval, a procurement objective was set up for the appointment of 41 physical 
reconditioning officers in the Medical Administrative Corps. The grades in- 
eluded 10 majors and 31 captains and first lieutenants. 

It is difficult to determine just what officials who set up this position had in 
mind since it was not clear in the job description. For example, the applicant 
must "have had adequate training and experience in educational guidance and 
reconditioning," while at the same time there must be "ability and experience 
in such technical subjects as anatomy and physiology." 83 The job description 
virtually closed the door to appointment, for a candidate must 84 

be above 38 years of age; must hold a master's or doctor's degree in physical education, 
education, or in related fields; must have achieved distinction in his profession, and must 
have had at least 10 years of successful supervisory and administrative experience as head 
of a recognized educational institution or program. Such experience must have been gained 
in a leading institution of higher learning or in a professionally recognized school or school 
system. 

However, according to the Deputy Surgeon General, "Athletic directors, 
coaches, trainers, and similar appointed personnel, ... are not suitable for 
use with convalescent patients," 85 while the letter from the Air Surgeon's 
Office stated that they "are not suitable for use as vocational and educational 
guidance officers." 86 These statements further narrowed the field inasmuch 
as it was hardly conceivable that men with degrees in education would have 
the necessary training and experience in anatomy and physiology required for 
reconditioning officers. 

After 6 months of recruiting, only two men had been appointed for duty 
with the Army Air Forces, and it was necessary for The Surgeon General to 



66 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



grant special dispensations in these cases. 87 It was at this point that Col. How- 
ard A. Rusk, Chief, Convalescent Training Division, Office of the Air Surgeon, 
initiated proceedings to have the job description changed. 88 He asserted that 
the original job description was designed for appointments as Chief of Recon- 
ditioning Services, and that no need existed for additional officers for such 
assignment in the Army Air Forces, although there was an urgent need for 
junior officers to be selected from enlisted men already in the program who 
would work under the Chief of Reconditioning Services. It was recommended 
that such appointments be made in the grade of second lieutenant. It appears 
from the recommendations of Colonel Rusk that the Convalescent Training 
Division was no longer looking for men to act in the dual capacity of educational 
and vocational guidance and physical reconditioning officers, but rather to the 
appointment of enlisted men who were already serving with the reconditioning 
program to be utilized exclusively as physical reconditioning officers. 89 The 
Office of The Surgeon General agreed to the suggested changes in the job 
description. 90 According to this new job description, a candidate for appoint- 
ment must hold a bachelor's or master's degree in physical education, education, 
or in related fields, and must have had 5 years of successful supervisory and 
administrative experience. 91 The requested changes were approved by G-i, 
and a procurement objective of 14 second lieutenants was allotted to the 
Army Air Forces. 92 Five appointments against this procurement objective 
had been made as of 11 April 1945. 93 

The Aviation Psychology Program was directed by Dr. John C. Flanagan, 
who was commissioned in the grade of major on 16 July 194 1. 94 Six other 
psychologists were subsequently commissioned in the same grade to plan and 
direct the program. 

In a study prepared for the Chief of Staff by Major Flanagan in December 
1941, 95 it was stated that all available Reserve officers with the necessary psycho- 
logical training had already been assigned to the project or to similar ones, that 
few junior officers could be expected from the officer candidate schools, and that 
in order to properly staff the project, it would be necessary to commission spe- 
cialists in psychology directly from civil life. It was recommended that an 
additional allotment of 42 officers be made to the Air Forces for accomplish- 
ing the psychological classification and research program, to be commissioned 
in the following grades: 6 majors, 12 captains, 12 first lieutenants, and 
12 second lieutenants. 96 This procedure having been approved, the Civil Service 
Commission, the National Roster of Scientific and Specialized Personnel, the 
American Psychological Association, and the American Association for Applied 



THE WAR MISSION 



67 



Psychology were asked to furnish names of psychologists. Men whose names 
were secured from these agencies and from other sources were rated by key 
personnel 07 

In the latter part of 1944, an urgent need developed for clinical psychol- 
ogists for duty with the Army Air Forces Convalescent Hospitals, and a request 
was made at this time for a procurement objective of 35 additional officers. 98 
This request was approved with the provision that these men be appointed 
from warrant officers and enlisted men possessing the proper qualifications for 
clinical psychologists and that they be appointed in the grade of second lieuten- 
ant. 90 It was agreed by the Psychological Branch of the Office of the Air 
Surgeon that these appointments would be limited to enlisted men on duty 
with the Army Air Forces. 100 Inasmuch as the majority of the candidates were, 
or had been, on duty with the Aviation Psychology Program, the Psychological 
Branch requested its officers in the various units to estimate the relative com- 
petence of each applicant. 101 After the ratings were received by the Office of 
the Air Surgeon, a list of names of the acceptable men was sent to The Adjutant 
General. Twenty-seven of these appointments had been made as of 27 January 
1945. 102 As of 10 April 1945, there were 182 officers on duty with the Aviation 
Psychology Program. Army Air Forces records of 138 of these officers 103 show 
that 56 were appointed from civil life, 53 from officer candidate schools, 22 
either from enlisted status or transferred from other units, and 6 from the Reserve 
Officers' Training Corps. 104 

In concluding this description of the Army Air Forces' personnel procure- 
ment program, the fact must not be lost sight of that never before had the air 
arm carried out such a major responsibility in connection with medical service. 
These developments were, however, but part of the pattern of the Army Air 
Forces medical service that was taking shape. Personnel procurement had 
been the major issue in 1942; in 1943 other issues were to emerge. 

The Issues Are Clarified: 1943 

'4 

As the summer and fall of 1942 passed, the Army Air Forces and Services 
of Supply (later Army Service Forces) 105 failed to reach agreement as to which 
medical functions belonged to each, and the period was marked by the Air 
Surgeon, on the one hand, expanding his program at Air Force bases and, on 
the other hand, by attempts on the part of the Surgeon General to restrain this 
trend. The latter still apparently viewed the Air Surgeon's Office as being 
a recalcitrant element which should be brought back into the fold of the 



68 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Army Medical Department, and to this end two studies were prepared during 
the summer of 1942. But by that time the Air Surgeon had decided that the 
Army Air Forces medical service could only be developed to meet the wartime 
emergency if there were a separate Air Force Medical Department altogether. 
In other words, the Air Surgeon would in fact if not in name serve as a Surgeon 
General and Air Force bases in the Zone of Interior would provide a system of 
hospitalization and administration for the Army Air Forces comparable to that 
of the Army. This was a valid concept if the basic premise were accepted that 
the Air Force was a weapons system and that the hospital, as a part of that sys- 
tem, must provide full medical care to insure the fighting effectiveness of the 
force. It was not a valid concept if the pilot was considered but one more digit in 
a vast Army composed of pilots and infantrymen, of truck drivers and cooks who 
all alike were caught in a vast "system" of medical care. It was not a valid 
assumption if the man were subordinated to the system. These, then, were 
the basic principles at stake but as the months passed they were often obscured 
by the personalities involved, so that activities were currently appraised in 
terms of The Surgeon General versus the Air Surgeon rather than in terms of 
the responsibility which each in obvious good faith was trying to discharge as 
senior medical officer of a major force in a time of war. 

By the fall of 1942, however, The Surgeon General had to face problems 
more complex and more extensive than those posed by the Army Air Forces. 
In September 1942 the Secretary of War and Chief of Staff appointed a com- 
mittee headed by Dr. Sanford Wadhams to review and evaluate the Army 
Medical Service. In its final report made in December 1942, the Wadhams 
Committee stated among other things that "The Office of The Surgeon General 
is accomplishing a satisfactory undertaking in a time of extreme stress, but there 
do appear to be certain administrative difficulties which could have been avoided 
by more aggressive action on the part of The Surgeon General." It noted, too, 
that the "semi-independence of the medical service of the Air Forces is most 
regrettable." Recommendations to remedy this situation were as follows: 106 

4. Believing that the Office of the Surgeon General is placed administratively at too 
low a level in the War Department, it is recommended that this office be placed on the 
Special Staff of the Chief of Staff. There should then be created on the staff of the Com- 
manding General, Services of Supply, the position of "Chief Surgeon, Services of Supply," 
with a rank commensurate with the position and involving responsibility and authority 
corresponding to that of The Air Surgeon and of the Ground Surgeon within their 
respective commands. Within each Service Command there should be a unified Medical 
Division, the Director of which should be on the staff of the Service Commander in 
charge of all medical activities. 



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69 



6. Every practicable effort should be made to bring medical service in the Air Forces 
under the supervision, authority and control of The Surgeon General. In the event no 
practicable means can be developed in this critical period, the Committee urges that a 
clear and concise delimitation of authority, responsibility and functions of The Air Surgeon 
under The Surgeon General be formulated and issued by proper authority. 

It was upon this note that the first year of the war came to an end. The 
Air Surgeon had not yet seen the report or registered his views. This would 
come some months later in connection with another report, the Hillman Report. 

The term of Surgeon General Magee would expire in May 1943 and 
during the next few months there was some uncertainty as to whom the 
President would appoint as his successor. His final choice was Maj. Gen. 
Norman Kirk rather than Maj. Gen. A. W. Kenner. The new Surgeon 
General was obviously concerned with the recommendation of the Wad- 
hams Committee regarding the elevation of his office to the Special Staff 
level, but his appointment did not automatically elevate his position to the top 
echelon, and throughout the war no such office was established per se. On a 
purely unofficial basis Maj. Gen. Howard McCrum Snyder, Assistant to the 
Inspector General, acted as "Eyes" and "Ears" for the Chief of Staff and medical 
matters were cleared through him at the Chief of Staff level. 107 General Kirk, 
however, was consistently to maintain the position that he was not merely The 
Surgeon General of the Army Service Forces but of the Army as a whole and 
as such was the senior medical adviser. On the other hand, General Arnold 
was, with the same degree of consistency, to maintain that The Surgeon General 
was under the command control of the Commanding General, Army Service 
Forces, Lt. Gen. Brehon B. Somervell. As a major force commander, General 
Arnold made it clear that he would not permit another force commander to 
control any element of his own force; that he was "not going to have Bill Som- 
ervell telling me how to run my medical service." 108 The diametrically op- 
posed viewpoints were soon to be tested as The Surgeon General began to 
develop a program designed to centralize the medical services of the Army 
Air Forces — described as semiautonomous by the Wadhams Committee — 
within his office. It had been suggested that "every effort" be made to cen- 
tralize it within the Office of The Surgeon General and, failing, that the 
responsibilities of the Air Surgeon should be clearly defined and limited. 
As a first step, The Surgeon General proposed to the Air Surgeon that he 
become Deputy Surgeon General, a position calling for a major generalcy. 
Convinced by now that such a plan would be detrimental to the Army Air 
Forces, General Grant refused personally to consider the suggestion, but agreed 



70 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



to pass along the recommendation to General Arnold. His feelings in the matter 
were illustrated by his stipulation to the Commanding General, Army Air 
Forces, that if such action were taken, he be transferred to an overseas 
assignment. Shortly thereafter the position of the Air Surgeon was elevated 
to that of a major general which brought the Air Surgeon to a rank comparable 
to that of The Surgeon General and placed him in a much stronger position than 
ever before. 109 

Meanwhile, in the 6-month period following the report of the Wadhams 
Committee, and prior to the swearing-in of the new Surgeon General, there had 
been a tug-of-war between the Office of The Surgeon General and the Office 
of the Air Surgeon over the problem of establishing rest and recuperation centers. 
Having been unsuccessful in bringing the Air Surgeon's Office under his 
control, The Surgeon General had turned his attention to medical installations 
on air bases. Since late 1942 the Army Air Forces had attempted to establish 
convalescent and recuperative centers in the Zone of Interior. Under existing 
regulations, personnel returning to Zone of Interior were under the jurisdiction 
of the Army Service Forces, and operational fatigue cases were treated in the 
general hospitals along with the general class of psychoneurotic cases. As a 
result, many of the flyers were lost to the Air Forces, which, according to the 
medical officers of the Air Forces, was due to a lack of "specialized therapy pro- 
cedures for highly specialized flying personnel" in the general hospitals. 110 It 
was further argued that this treatment could not be given in such hospitals. 
In a memorandum to the Chief of Staff 111 requesting the necessary authority 
to establish and operate specialized hospital and recuperative centers for the 
personnel of the Army Air Forces, it was pointed out by the Air Staff that the 
program would entail no extra cost over the present arrangement, since the 
general hospital facilities now in use would be released, and that in addition 
an over-all saving would be effected as a result of salvaging a greater number 
of combat personnel. 

To this request, The Surgeon General wrote his dissent in unmistakable 
language. 112 He said in part : 

It is made to appear that his [the airman's] fractures, burns, acute infections, and mental 
disease must be treated by medical officers with a psychological approach peculiar to them 
and known to no others. By the same token paratroops, and infantrymen should be given 
definitive medical care by medical officers who eat and sleep and constantly associate with 
them and who are capable of "speaking the language" of the particular service concerned. 

In brief, he recognized no operational fatigue or other disease caused by combat 
experience and Air Forces personnel could presumably be treated as adequately 
in general hospitals as in special hospitals operated by the Air Forces. The 



THE WAR MISSION 



71 



Commanding General, Services of Supply, agreed "completely" with The 
Surgeon General and therefore failed to concur in the establishment of special- 
ized hospital and recuperative facilities for the Army Air Forces. 113 Although 
failing to concur in the establishment of special hospital centers, The Surgeon 
General did, however, approve the organization of non-medical rest centers 
for both combat and Zone of Interior personnel. 114 

The Air Forces, however, continued to press for the necessary War De- 
partment authority which would enable them to deal with the convalescent 
problem within the Air Forces. The Chief of the Air Staff observed in connec- 
tion with the nonconcurrence of The Surgeon General that the opinion was 
based on a "lack of knowledge and understanding of the problem involved 
as pertains to Army Air Force combat crew members." The position of the 
Air Staff was stated bluntly: 115 

It is believed that specialized treatment for staleness, anoxia, operational fatigue, aero- 
neurosis, aero-embolism, and the other unique strains encountered only in flying is manda- 
tory if the individual is to be returned to flying as a successful air crew member and not to 
sacrifice his previous training, combat experience and other demonstrated capabilities. 
The very rapid and continuous change of altitude, for example, sea level and desert heat and 
ending at 30,000 to 35,000 feet in sub-zero temperature within a short space of time, produces 
an additional and unique strain not associated with other forms of combat work, which has 
been entirely overlooked by those not familiar with the problems of flying. 

On 6 February 1943, G-4, recognizing the need for rest and recuperative 
facilities for military personnel, discussed the problem in a memorandum to 
G-i. 116 Reference was made to the current demands of the Army Air Forces for 
rest centers, and it was thought likely that the Army Ground Forces and the 
Services of Supply would be interested in rest facilities for their fatigued person- 
nel, probably to a lesser degree than the Army Air Forces. It was foreseen that, 
as casualties increased, recuperative facilities would be needed for personnel 
recovering from recent hospitalization and also for personnel who did not need 
hospitalization, but rest. The latter group would experience increasing difficulty 
in caring for themselves after returning to this country due to food rationing and 
high prices. However, G-4 held that the immediate needs of the combat zones 
for rest centers involving psychiatric study should be the responsibility of the 
theaters of operation. Concerning the personnel returning to the United States, 
it was believed that this personnel would either be physically fit for furloughs 
or be in definite need of hospitalization, and the problem was one that would 
arise in the future as casualties increased. G-4 further advised G-i that, "if, in 
your opinion, the time has arrived to consolidate planning on this subject, it is 
recommended that you conduct a survey to determine a line of departure for 



72 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



action." G-i followed this suggestion by sending a copy of the G-4 memoran- 
dum to all interested agencies of the War Department for comment. By 4 May 
1943 answers from all the agencies had been received. 117 

The Commanding General of the Army Ground Forces was of the opinion 
that it was unnecessary at this time to consolidate planning for rest and recupera- 
tive facilities for military personnel. Among the reasons given to substantiate 
this position were these: The number of personnel returning would be too 
small to warrant the expenditure necessary; the majority of personnel would 
prefer to go home for rest and recuperation ; the plan would entail considerable 
expense and require additional manpower; and, finally, there was no need for 
rest facilities for personnel in training in this country because of the frequency 
of passes and furloughs. It was agreed, however, that rest camps should be 
considered at this time for overseas theaters. 118 The Commanding General of the 
Army Service Forces was opposed to establishing rest and recuperation facilities 
in the United States for personnel of the Army Service Forces, and, therefore, 
fully concurred in the memorandum of the Commanding General of the Army 
Ground Forces of 25 February I943- 119 

G-i was not in accord with the position taken by the Army Ground Forces 
and the Army Service Forces, and its views were stated in part as follows: 120 

There is a definite need for rest and recuperation facilities for all components of the 
Army . . . 

The needs for rehabilitation centers are for the care of men who are able to leave 
general hospitals but who require further rest, a period of convalescence, psychiatry or 
occupational therapy treatment, which treatment could be accomplished at these centers, 
thus clearing general hospitals for new casualties. Due to the cost and time required to 
train air combat crews, it is obvious that steps should be taken to salvage as many crew 
members, returning from combat and suffering from operational fatigue, as possible, in the 
least practicable time. This can best be accomplished through immediate specialized treat- 
ment in hospitalization and recuperation centers operated by or for the Army Air Forces. 

It is recommended that the establishment of rest and recuperation facilities, as requested 
by the Army Air Forces, be provided for the battle casualties of the whole Army. 

After comments had been received from all interested War Department 
agencies, G-4 announced a conference to be held on 7 May, with each agency 
requested to send a representative. 121 At this conference it was agreed that the 
recommendation of the Commanding General of the Army Air Forces should 
be presented to the Chief of Staff for his consideration. Then G-4 added: 122 

It is the opinion of this Division that the Army Air Forces failed to clearly state main 
purpose for which this specialized treatment of air crew personnel is based. The point of 
issue is the fact that' a normal decrease in efficiency due to operational flying fatigue will, 
if not properly detected and treated, result in excessive operational accidents with a resultant 



THE WAR MISSION 



73 



damage to equipment and loss of highly trained personnel, and that the providing of leaves 
or furloughs is not adequate treatment in many cases. The detection and determination 
of the degree of flying fatigue requires close observation by trained personnel. The Army 
Air Forces, for more than 20 years, have given special training to medical officers in the 
care and examination of the flier and have the bulk of the qualified flight surgeons which 
are required for the proper handling of such cases. 

It has been demonstrated by British experience that if flying fatigue is possessed beyond 
a certain point it is not possible to rehabilitate personnel to an extent that restores their 
military usefulness. It is also essential that in severe cases of flying fatigue the proposed 
treatment be initiated promptly in order to offset a mental condition which might be present. 

This was in keeping with an earlier conference in which the staff of the 
Air Surgeon had developed these points: 123 

1. More than 50,000 members of the Air Forces will be in the combat zone by January 
1, 1944, and thus the need for this facility will become greater. 

2. The present allotment to the Air Forces of 4.5 medical officers per 1000 men need 
not be increased; therefore no additional medical personnel will be required. 

3. With reference to hospitalization, no increase in beds for the entire Army will be 
necessary, and the approval of these facilities will reduce, in proportion, the number of 
beds needed in general hospitals. 

4. No construction will be necessary as hotels not needed for civilian purposes can be 
utilized. 

5. Quite frequently the Army Air Forces lose track of personnel returned from combat 
for hospitalization when the rehabilitation period is prolonged. This proposed system 
will eliminate this delay and the much needed combat crewmen would be reclassified and 
returned to duty much sooner. 

6. It is not proposed in this plan to treat patients suffering from battle wounds. These 
cases will continue to be sent to general hospitals and, when released, would be referred to 
this facility to be classified and rehabilitated when necessary. 

7. The United States Navy now has a similar facility for their combat crewmen. 

8. The RAF also has a system very similar, except they, in addition, operate their own 
general hospitals and their combat crews are returned from war theaters after a definite 
number of hours of combat in the air and assigned to a recuperation hospital for treatment 
and rehabilitation when necessary. The necessity is decided by a disposition board 
consisting of fligh t surgeons. 

G-i submitted the problem of specialized treatment for aircraft combat 
crew personnel to the Chief of Staff in a memorandum dated 25 May 1943. 124 
The Chief of Staff apparently discussed the matter with the Secretary of War, 
for it was noted that the approval announced by the Chief of Staff was also 
personally approved by the Secretary of War. 

Convalescent centers were approved for the Air Forces to serve those com- 
bat crew members who suffered from operational fatigue and also for all Air 
Service personnel who had been hospitalized in general hospitals for disease, 



74 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

injury, or battle casualty. These centers would be equipped with the minimum 
facilities from the standpoint of surgery and medicine to care only for such 
acute disease or illness as might occur. They would not operate as general hospi-^ 
tals, except that authority was granted to the Station Hospital at Coral Gables, 
Fla., to function as a general hospital only for the purpose of reclassifying officers 
for limited service and for appearance before retiring boards. 125 It was further 
agreed that, should an increase in bed facilities be necessary to meet the present 
accepted standards, authorization for leasing or construction would be forth- 
coming. 126 "Convalescent centers" were activated on 18 September 1943 at sta- 
tion hospitals located at Coral Gables, Fla.; Buckley Field, Colo.; San Antonio 
Aviation Cadet Center, Tex. ; Santa Ana Army Air Base, Calif. ; Maxwell Field, 
Ala.; Mitchel Field, N. Y.; Fort George Wright, Wash.; and Jefferson Bar- 
racks, Mo. 127 Approximately 9 months had passed since the Commanding 
General of the Army Air Forces asked permission to establish such convalescent 
centers for Air Forces personnel. 

Surgeon General Kirk apparently viewed the development of convales- 
cent centers with concern, especially the fact that the station hospital at Coral 
Gables was to function as a general hospital. The convalescent hospital system 
could indeed constitute a very real threat to the traditional system by which 
patients were returned from overseas theaters for treatment; the precedent of 
authorizing the Army Air Forces to operate a general hospital could jeopardize 
the general hospital system. The Army Air Forces, however, was learning by 
experience that the hospitalization and evacuation system must support the Air 
Force mission and that to conserve the fighting strength and return , the flyer 
to duty as rapidly as possible the Air Forces must retain continuous administra- 
tive control of the patient. 

During the late winter of 1942 and the spring of 1943 as manpower became 
increasingly critical, the AAF was able to harbor its resources in a manner 
which would not have been possible if so many specialists had not during the 
spring of 1942 chosen duty with Army Air Forces. This meant that the poten- 
tial at certain Air Force station hospitals was such that care could be provided 
at base level comparable to that of a general hospital, providing equipment was 
available. Man-days were saved which ordinarily would be spent in travel and 
in administrative processing. There was no chance of the patient being lost 
to the Air Forces and reassigned elsewhere since continuous control was 
exercised. The medical staff was familiar with the individual case and the 
rapport established proved a boost to the mental well-being of the patient as 
well as to his physical well-being. Moreover, a factor always held important by 



THE WAR MISSION 



75 



the Air Force was demonstrated, namely that the patient recovered more rapidly 
in familiar surroundings where he could maintain close contact with his daily 
associates. Thus, the Air Forces was carrying out a policy based upon sound 
principles and demonstrable in part by the fact that the health of the Air Forces 
was consistently higher than that of the ground forces. By the winter and 
spring of 1943 this development had become a matter of major concern to The 
Surgeon General who saw in it a second threat to the general hospital system. 
After a visit to Maxwell Field, Alabama, for example, Brig. Gen. C. C. Hillman, 
a member of his staff, reported that the station hospital there was operating as a 
small general hospital; that it was overcrowded, which necessitated the use of 
barracks not designed for hospital purposes; and yet, only 12 beds of a 45-bed 
allotment at Lawson General Hospital, Georgia, was being utilized. He noted, 
however, that he found the morale of the personnel high, the equipment in good 
condition, departments well policed, and that the hospital had "the appearance 
of being well run." 

The controversy mounted. In addition to the Wadhams and Hillman 
Reports, the Commanding General, ASF, was, in April, to receive yet another 
report in the form of a memorandum from The Surgeon General deploring the 
current trend in the Army Air Forces toward separate hospitalization. 128 This 
communication, 129 appearing to have been in large part responsible for the initia- 
tion of the move by the Army Service Forces to control the medical service of the 
Army Air Forces, should be discussed in this connection, even though it was not 
transmitted to the Air Surgeon for comment. In this communication The 
Surgeon General observed that it was unfortunate to have separate hospitals 
for the Air Forces; that the Air Surgeon's Office was duplicated by the Office 
of the Service Command Surgeon; and that the Air Surgeon intended "to 
promulgate a separate air general hospital function for patients from air station 
hospitals, or from overseas via air evacuation." 130 In support of this statement 
The Surgeon General called attention to AAF Regulation No. 20-15, 1 Febru- 
ary 1943, which exempted the Breakers (Hotel) Hospital and the Miami-Bilt- 
more (Hotel) Hospital from corps area control and placed them under the Air 
Surgeon. This he interpreted as the first step in initiating the general hospital 
program for the Air Forces, a program which he considered serious because of 
the shortage of medical personnel and supplies. 

Already, he said, numerous Air Force station hospitals were hospitalizing 
more than 4 percent of the command. "Inquiry as to the cause for this over- 
crowding has elicited the fact that most of the posts where this overcrowding 
occurs are either acting as pseudo general hospitals receiving patients from other 
Air Force hospitals, or are not utilizing general hospitals, or both." He objected 

262297°— 55 7 



76 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



also to the thesis that the medical service for airmen must be rendered by medical 
officers "speaking their language/' for he said, "This is one Army." He recom- 
mended, therefore, that "hospitalization of Army Air Forces personnel be made 
a responsibility of the service command; that only medical department personnel 
attached to field units of the Army Air Forces be directly responsible to the Air 
Force Surgeon," and, finally, that the matter "be presented to the Chief of Staff 
for clear delineation of the responsibilities of The Surgeon General of the Army 
for health of the entire Army." 

Apparently impelled by this memorandum and strengthened by the Wad- 
hams and Hillman Reports, The Commanding General, Army Service Forces, 
initiated action to centralize medical services within the Service Command. In 
a memorandum dated 30 April 1943 for the Chief of Staff, he said in part: 131 

1. a. The authority of The Surgeon General as the chief medical officer in the War 
Department requires early clarification; until such is clearly established the unified super- 
vision and administration of the military-medical service so essential for efficiency, economy, 
adequate operations and satisfactory results will continue to be difficult. 

b. Certain findings and recommendations included in the report submitted to the 
Secretary of War by the Committee to Study the Medical Department of the Army . . . 
confirms the necessity stated, as does a communication from The Surgeon General dated 
April 12, 1943. 

Appropriate letters for inaugurating this unification program were included 
for the signature of the Chief of Staff. 132 This study was buttressed by extracts 
from the Hillman Report 133 and the Wadhams Committee. 134 The basic study, 
together with accompanying documents, was sent by the Chief of Staff to the 
Commanding General, AAF, who in turn submitted it to the Air Surgeon 
for comment. 

In connection with the Hillman Report, the Air Surgeon admitted that in 
many instances Air Forces station hospitals were "performing medical service 
comparable to that found in general hospitals. . . 136 This practice was 
justified by Circular Letter No. 61, Surgeon General's Office, dated 27 June 1942, 
paragraph 4, which stated: "No hard and fast rule can be laid down, but in 
general, it will be the policy of the Medical Department to treat as general 
hospital cases all patients who require more than 90 days hospitalization, as 
well as all cases requiring operating treatment which is not available at station 
hospitals." In further defense of the practices in station hospitals, paragraph 5 
of the same circular was quoted: 

•Major surgery of elective type is normally a function of a general hospital and such cases 
would ordinarily be transferred to the nearest general hospital; however, when, in the opinion 
of the Corps Area Surgeon or in the case of Air Force stations the Surgeon of the Army 



THE WAR MISSION 



77 



Air Forces, the facilities are adequate and the proficiency of the surgical staff such as to 
warrant it, such operations may be performed at station hospitals. 

It was also noted that certain types of cases from overseas were being retained 
by Air Forces station hospitals, and that authority for this practice was con- 
tained in Circular No. 5, paragraph 8. Exception was taken to the statement in 
the memorandum from the Assistant Chief of Staff for Operations, Army 
Service Forces, which contended that "Existing directives are not being complied 
with, and probably will not be, until a specific decision of the Chief of Staff is 
published." 136 

Turning then to the statement in the Wadhams Report which said, "The 
semi-independence of the medical service of the Air Forces is most regrettable," 
the Air Surgeon noted emphatically that it was a matter of opinion not sup- 
ported by evidence and that "the committee as constituted lacked military medi- 
cine — much less aviation medicine — to be considered authoritative." 

The Air Surgeon concurred in the recommendation that The Surgeon Gen- 
eral be on the special staff of the Chief of Staff, but took exception to the recom- 
mendation that the Air Forces medical service be brought under the authority 
and control of The Surgeon General. To do so would violate "command func- 
tions under the present organization of the Army, delegating to one command, 
command functions over a command of equal authority." He also challenged 
the statements that "confusion exists as to a unified medical service" and that 
"operations of the medical service within the Army Air Force will result in 
duplication of medical plant, personnel, and equipment requirements and 
capacities." 

The Commanding General, Army Air Forces, concurred in the memo- 
randum of 30 April 1943 for the Chief of Staff from the Commanding General, 
Army Service Forces, subject to reservations, but this concurrence had little 
tangible meaning for The Surgeon General because the Commanding General 
noted that the "Medical service within the AAF is now operating on a satis- 
factory basis and no substantial changes in present organization or procedures 
or in relation with The Surgeon General can be concurred in at this time." 137 
The entire case was submitted to the Assistant Chief of Staff, G-4, who 
prepared a staff study for the Chief of Staff. 138 That office after investigating 
reasons for the recommendation of the Commanding General, Army Service 
Forces concluded: 139 

Basically, The Surgeon General opposes the gradually growing independence of The 
Air Surgeon on the grounds that independence leads to duplication of facilities and opera- 
tions. The Air Surgeon, on the other hand, contends that the greater efficiency of his 



78 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



system justified its semiseparation on all grounds, including economy. The Surgeon Gen- 
eral admits a difference in efficiency. It results from several causes, among which are the 
difference in magnitude of the two problems, the greater authority over his personnel 
and facilities enjoyed by The Air Surgeon, and the difference in internal organization 
channels in which the two work. 

The alternatives were stated in this manner: 

A decision at this time must choose between, on the one hand, a definition of author- 
ities which appears to achieve complete unification but which will work effectively only 
with the enthusiastic concurrence of all concerned and with a considerable improvement 
in the medical service of the Army and, on the other hand, a definition of authorities 
which will certainly achieve more efficient medical care for one part of the Army but which 
is a trend definitely away from unification. 

The latter alternative was chosen, with the explanation that "This choice 
is dictated to a certain extent by expediency, but with the thought that greater 
efficiency in one part of the Army should serve as an incentive to the remainder." 

The Chief of Staff made his decision in line with the recommendations of 
G-4 and announced these principles for the guidance of The Surgeon General 
and the Air Surgeon: 140 

a. Procurement of medical personnel will be handled by The Surgeon General on an 
over-all basis, with such decentralization to the major services as The Surgeon General 
deems appropriate. 

b. Station hospitals on Air Force posts, camps, and stations are under the command 
of the Commanding General, Army Air Forces. 

c. Aviation medicine and medical treatment of combat crews are Air Force responsi- 
bilities which will be discharged by the Air Surgeon. Such general hospitals as are 
necessary to meet this need will be assigned to the Army Air Forces upon approval by 
the Chief of Staff, 

The policies set forth in this memorandum obviously disappointed the 
Commanding General, Army Service Forces, and The Surgeon General, espe- 
cially the provision for assignment of general hospitals to the Air Forces. Steps 
were immediately taken to have this part revoked, although the procedure used 
in effecting this change is not a part of the AAF record. 141 It appears, however, 
that The Surgeon General appealed the decision of the Chief of Staff to the 
Secretary of War, and the discussions in connection therewith were carried on 
by means of the telephone or by hand-processed memoranda that never reached 
the official files; for on 9 July 1943 a corrected copy of the 20 June 1943 mem- 
orandum was issued by the Chief of Staff in which that part making provision 
for the assignment of general hospitals to the Air Forces was deleted. 142 Thus 
ended one of several determined efforts of the Army Service Forces to cen- 
tralize activities of the Air Surgeon's Office. 



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79 



In contrast with the attitude of the Army Surgeon General, members of the 
civilian medical profession were enthusiastic about the Army Air Forces pro- 
gram. In June 1943 following the recent swearing-in-ceremonies of the new 
Surgeon General, General Grant had discussed the AAF program at the 
meeting of the House of Delegates of the American Medical Association 
in Chicago. At the close of his remarks he received a standing ovation from 
the audience and Dr. Arthur T. McCormack of Kentucky "moved that this 
statesmanlike address containing the sound principles that it does be referred to 
the Council on Medical Education and Hospitals with the commendation of the 
House." This motion was unanimously adopted and letters of appreciation 
were sent by the American Medical Association to the Secretary of War and to 
General Arnold. 143 

Surgeon General Kirk, however, had just received a major setback in his 
attempt to centralize Army Air Forces medical service within his office: not 
only did the AAF retain control of its medical installations and of medical 
care for combat crews, but G-4 had recommended that, if the Chief of 
Staff approved, such general hospitals as necessary be assigned to the Army 
Air Forces. Implementation of this latter step had barely been avoided. He 
now approached the problem in a different manner by severely restricting the 
type of surgery that could be performed at AAF station hospitals. On 19 July 
1943, in War Department Circular No. 165, 144 "elective surgery" was defined 
in such a manner that it could be performed only in general hospitals. It 
would include "fractures of the long bones, complicated fractures, fractures 
of the facial bones, fractures of the pelvis, with the exception of simple fractures 
that will not require in excess of 90 days hospitalization." As a result of this 
action, the station hospitals of the Army Air Forces were limited in the type 
of service which could be rendered by these specialists, and highly skilled 
specialists would be declared surplus and transferred to Army general hospitals. 
Through the summer of 1943, however, station hospitals of both the Army 
and the AAF apparently did not follow the definition of elective surgery 
very closely, for in the fall of 1943 The Surgeon General complained that the 
meaning of "elective surgery of a formidable type" had not been clearly under- 
stood. His recommendations to clarify the matter appeared in an amendment 
to War Department Circular No. 304, which, in effect, reduced the Air 
Forces station hospitals to dispensaries. 145 

The representatives of the Air Forces immediately began a movement to 
obtain relief from the provisions of these circulars. The Air Surgeon sent a 
memorandum to the Commanding General, Army Air Forces, on 29 Novem- 
ber 1943 in which the problem was discussed at length. 146 First, he noted, the 



80 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

policy established by these circulars was clearly in opposition to the command 
responsibility of the Commanding General, Army Air Forces. Moreover, the 
basic principle of military medicine was "to provide medical care for the sick 
and the injured with minimum number of days lost from duty, and in nearest 
adequate facility," a principle which was violated by both War Department 
Circulars 165 and 304. It was pointed out further that the Air Forces' medical 
plan reduced time lost from duty; provided "complete treatment, convalescence 
and rehabilitation in the nearest medical facility"; and permitted full utilization 
of medical personnel. On the other hand the policy of The Surgeon General, 
if allowed to remain in effect, would completely destroy the medical service of 
the Air Forces in that $250,000,000 worth of station hospitals fully staffed and 
equipped were reduced to dispensaries. These hospitals, completely staffed, 
must remain so to take care of emergencies, yet The Surgeon General's policies 
would now prevent their full use. 

These facts were reiterated in a memorandum from Arnold to the Chief 
of Staff on 26 December. He noted that as Commanding General, Army Air 
Forces, he was responsible for the care, control and utilization of 2,300,000 
officers and enlisted men. He was similarly responsible for utilization and 
operation of 237 hospitals and 144 dispensaries- at Army Air Forces stations in 
the United States having a capacity of 74,431 beds, representing a Government 
outlay of $250,000,000. He pointed to the fact that medical officer personnel 
assigned to the Army Air Forces numbered more than 10,000 of which over 
9,000 volunteered from civil life for service with the Army Air Forces and some 
4,000 ranked as specialists. Because of this staffing capability, approximately 60 
Army Air Forces hospitals had been investigated and approved by the American 
Medical Association as residencies of medicine and surgery and approximately 
the same number inspected and awarded certificates of excellence by the 
American College of Surgeons. With this equipment and personnel, the Army 
Air Forces had undertaken a program which emphasized preventive steps to 
reduce the number of cases, to maintain a convalescent-rehabilitation program 
designed to minimize days lost to the service, to return personnel to duty in 
the best possible condition for service, to maintain morale of hospitalized 
personnel, and to continue training during hospitalization to the maximum 
extent. The success of this program, he noted, was attested by the fact that the 
rate of admission to hospital and the days of service lost to Army Air Forces 
personnel had been consistently lower than the corresponding figures for the 
other Army forces. In the past 6 months in the continental United States the 
rate of admission had been less by a differential varying from 10 to 20 percent 
than comparable rates of other Army forces. The days lost by personnel treated 



THE WAR MISSION 



81 



at other Army Air Forces installations exceeded those lost by personnel treated 
at Army Air Forces station hospitals by from 16 to 50 percent. 147 

The 29 November memorandum prepared by the Air Surgeon, mean- 
while, served as the source of an Army Air Forces memorandum to the War 
Department General Staff in which it noted: 145 

Under the provisions of paragraph 4 a and b, Circular 304, War Department, 1943, the 
Commanding General, Army Air Forces, can no longer provide the medical services at 
his stations which in his considered judgment are vitally important. His medical installa- 
tions are reduced in scope to dispensaries; the retention therein of highly skilled surgeons 
and physicians is unwarranted and wasteful; an invaluable element of his command, 
contributing greatly to the successful performance of his mission, is emasculated. 

It was recommended that the Army Air Forces be excepted from compliance 
with paragraphs 4 a and b of War Department Circular No. 304; and further, 
"that proposed plans and programs of other War Department agencies which 
directly affect personnel planning and operations of the Army Air Forces, be 
submitted to this Headquarters for comment prior to publication." 

G-i transmitted the memorandum to Military Personnel Division, Army 
Service Forces, 149 which in turn referred it to Office of The Surgeon General for 
remark and recommendation. 160 While admitting that medical personnel must 
be on hand to render prompt and effective service for emergency cases, that office 
denied the necessity of including elective surgery in this medical service. Cases 
involving elective surgery should be sent to general hospitals where specialists 
were available for such operations. 151 According to The Surgeon General, a 
shortage of doctors for the Army as a whole existed, increasing demands for 
medical personnel in the theaters of operations must be met, and it was planned 
to transfer the specialists from the station hospitals. Even the general hospitals 
were being specialized for certain types of cases. 152 As a result of his plan 
many specialists would be made available for service with overseas troops, 
while at the same time better, more specialized service would be in effect in 
the general hospitals. 153 These ideas were incorporated in a memorandum 
transmitted to G-i by the Commanding General, Army Service Forces, with 
full concurrrence "in all particulars," and it was recommended that the request 
for action to except the Army Air Forces from the provisions of paragraphs 
4 a and b of War Department Circular No. 304 be denied, 154 

The Deputy Chief of Staff, however, directed G-i to reconsider Section II 
of Circular No. 304 on the basis of the following: 

a. The Army Air Forces must make available their proportionate share of medical 
officers for overseas assignment . • . 



82 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

b. Army Air Forces bases must have available in their station hospitals sufficient medical 
facilities and surgical skills to handle promptly and efficiently injuries due to airplane 
accidents. 

c. There should be no absolute prohibition of elective surgery in Army Air Forces 
hospitals where facilities are available . . . 

The decision as finally written was embodied in paragraph 4 d, War Depart- 
ment Circular No. 12, which read: 155 

At Army Air Forces stations where sufficient medical and surgical facilities must be 
maintained to handle injuries promptly and efficiently due to aircraft accidents, elective 
surgery may be performed if facilities and specialists are available. Medical facilities pro- 
vided to handle aircraft accidents will be utilized to handle other types of medical and 
surgical cases to the extent possible without interference with the requirements that they 
be able to meet emergencies incident to aircraft accidents. 

Thus the Army Air Forces station hospitals in the Zone of Interior were per- 
mitted to provide medical services within the limit of their capability. 

Out of the experience of the last year were to come two activities which 
would be mutually beneficial to the Army and the Army Air Forces, First, 
The Surgeon General requested that the Air Surgeon furnish him a flight 
surgeon for duty in his office, "to advise concerning specialized treatment, trans- 
fer, and disposition of combat crews." This request not only was approved by 
the Chief of Staff, but had the personal approval of the Secretary of War. As a 
result, Col. A. H. Schwichtenberg (MC) was placed on detached service from 
the Air Surgeon's Office and assigned to The Surgeon General's Office as Liaison 
Officer. 156 His was a most difficult role. Although it was possible to avoid 
numerous actions which would have had adverse effects both upon the Air 
Forces medical service as well as that of the Army, he was by no means success- 
ful in resolving many of the most fundamental issues because of the strong op- 
posing convictions held by the Air Surgeon and The Surgeon General. He was, 
however, to be of material assistance in furthering the progress of the air evacua- 
tion planning and obtaining authorization for its use in continental U. S. and 
was ultimately assigned as Deputy Chief of the Operations Divisions for Domes- 
tic Operations evacuation under Brig. Gen. R. W. Bliss. He aided materially 
in the development of the Medical Regulating Office system. 

The second activity which helped alleviate the critical situation was the 
assignment of a flight surgeon in each general hospital where flying combat 
personnel were hospitalized. 157 The Personnel Distribution Command was 
given the responsibility of designating flight surgeon consultants for duty in 
the general hospitals and supervising their work. 158 Subsequently an Air 
Force liaison officer system was established which greatly facilitated the reas- 



THE WAR MISSION 



83 



signment of Air Force patients. Nearing completion of their hospital stay the 
liaison officer would communicate directly with the personnel assignment 
officers in appropriate Air Force headquarters and at the time the patient 
was ready for discharge from the hospital an assignment awaited him. This 
was so successful that it was later copied by the Army and was a major con- 
tributing factor in shortening the length of stay of Air Force personnel in the 
general hospital system. 

The Mounting Crisis: 1944 

These surface actions, however, could not solve the fundamental problem 
of whether a nonservice force should control the medical component of a 
combat force* Throughout the war the Air Staff had given its firm support 
to the Air Surgeon who, upon the basis of his experience, had determined 
that the Army Air Forces must operate its medical service including general 
hospitals for Air Force personnel. He had not looked favorably upon the 
attempts of The Surgeon General to limit the type of service that could 
be permitted at station hospitals, and it was apparent that future attempts 
on the part of The Surgeon General to determine Army Air Forces requirements 
would be firmly resisted. Through the past two years the major problems 
relating to hospitalization had been primarily concerned with Zone of Interior 
facilities. By the end of 1943, however, these problems had been largely 
resolved with the publication of the War Department directive which clarified 
Army Air Forces responsibilities for hospitalization and aircrew care. 
Whether the basic principles established in War Department Circular 120 
applied to overseas theaters had yet to be determined. 

In the theaters the Army Air Forces controlled no fixed medical installa- 
tions larger than the 25-bed aviation medical dispensaries. Since the North 
African Campaign complaints had been coming informally to the Air Sur- 
geon's Office from overseas air surgeons. As an emergency measure, Air Force 
personnel in the North African and Tunisian Campaigns had been hospitalized 
in British hospitals. A partial solution to the problem of hospitalization had 
been found as the Allies moved into Sicily and Italy. General hospitals were 
assigned to the Air Forces, and the aviation medical dispensaries provided 
service at small air installations. From the China-Burma-India theater, pri- 
marily an air theater, complaints were received because of the need to send 
patients to Services of Supply installations involving a loss in precious man 
days to the Air Forces. From the Pacific likewise came complaint after 
complaint. 168 It was from the European theater, however, that explosive 
action was shortly to come, bringing the whole problem to the White House. 



84 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

As the war effort gained momentum in the winter and spring of 1944 it 
was apparent that the issues would soon have to be defined. Moreover, the 
advances in fighter aircraft had been of such magnitude that organizational 
concepts for tactical air forces were changing and planners were concerned, 
among other things, with the problem of integrating the medical element to 
support the force in its field mission. There were two aspects to the problem: 
The first dealt with airborne medical facilities and personnel which would 
accompany the forces to the combat area ; and the second dealt with the problem 
of caring for aircrew personnel hospitalized at fixed installations in the Zone 
of Communications. 

It appeared that determination of the medical plans, policies and organi- 
zational concepts for servicing the tactical air forces in the combat areas would 
be largely a problem of the major force involved, i. e., the Army Air Forces. 
The problem of fixed hospitals in the Communications Zone to provide more 
elaborate care, however, was one that promised to cause as much debate as 
had the problem of station hospitals in the Zone of Interior. It will be recalled 
that the War Department reorganization which established three major forces 
provided a pattern for overseas organization: ground, air and services forces were 
co-equal in status, and all subject to the command control of the theater com- 
mander. In a theater of operations, all fixed installations including medical 
were under the control of the Services of Supply. This was in accordance with 
the traditional administrative organization which provided for the combat and 
noncombat zones to be served by combat and noncombat personnel. 

Long-range aircraft, however, had rendered obsolete these traditional or- 
ganizational concepts developed to serve surface-borne troops. This meant 
that the air bases of a single long-range flight might traverse both the Com- 
munication and Combat Zones with the target beyond enemy lines. The 
important point for consideration, then, was one of administration: Was it 
better military management to utilize SOS facilities — at the same time 
relinquishing administrative control of highly trained aircrew personnel to 
the ponderous SOS administrative system — or to provide station hospitals to 
care for the sick and wounded. Since the long term sick and wounded cases 
could not be as satisfactorily rehabilitated for flying as for ground duty, they 
would be returned to the Zone of Interior. The need for general hospitals 
was therefore limited and the procedure used in the Mediterranean was basically 
satisfactory; there general hospitals had been assigned for Air Force use. 
The Air Forces did, however, require station hospitals in the overseas hospitals 
comparable to those under Air Force control in the Zone of Interior. 



THE WAR MISSION 



85 



While the Air Staff in accordance with Arnold's wishes had consistently 
supported the recommendations of the Air Surgeon for the AAF hospitalization 
program in the Zone of Interior, it was not until late 1943 that they faced 
the problem of overseas hospitalization. It was to crystallize in terms of 
the troop basis. The Eighth Air Force plan, for example, provided for 
four field hospitals (airborne), the theater surgeon and The Surgeon Gen- 
eral having both concurred to the assignment of these hospitals to the Eighth 
Air Force. The Air Staff, however, agreed to the deletion from the Eighth 
Air Force Troop Basis of these hospitals because the current Army Air Forces 
Troop Basis did not provide for overseas hospitals. A similar situation developed 
in the Fifteenth Air Force plan where, again, field and station hospitals were 
deleted and where also a certain number of medical dispensaries were reduced 
and others eliminated altogether. Other requests disapproved were for veteri- 
nary officers and medical sanitary officers. In yet another area of responsibility, 
the Air Staff disapproved the request of the Air Transport Command to provide 
hospitals for bases along Air Transport Command routes, noting that hospital- 
ization outside the continental United States was the responsibility of the Army 
Service Forces and The Surgeon General. 

In late November 1943 the Air Surgeon brought all these matters to the 
attention of Lt. Gen. B. M. Giles, C/AS, with a strong statement that "In recent 
weeks it has become increasingly evident that the desires of the Commanding 
General, Army Air Forces, with regard to the medical services of the Army Air 
Forces are not fully understood by all members of the Air Staff." General 
Arnold, he stated, desired that the best possible professional medical care to all 
members of the Army Air Forces be provided, "regardless of where they are 
stationed." He noted further that medical care of Air Force personnel "does 
not end with the squadron Flight Surgeon, but that to assure the maintenance 
of the striking force of the air command, medical service must include hospital, 
sanitary, and daily hygiene inspection facilities." 160 

The Air Staff responded quickly. At their request the Air Surgeon's Office 
outlined the basic problem and its underlying causes, which was a matter of 
interpretation of the March 1942 directive. Noting that with the War Depart- 
ment reorganization, responsibility for medical service including hospitalization 
on air bases within the continental United States was given to the Commanding 
General, the Air Surgeon's Office stated that the problem of providing an 
adequate service on air bases outside the continental bases was "certainly no 
different in principle than that encountered on air bases within the United 
States." 161 It was strongly recommended that the Air Force troop basis pro- 
vide hospitals for air bases outside the continental United States. That the 



86 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



War Department was aware of the specific needs of its components was apparent 
in the fact that ground troops were provided "hospitals" which included clearing 
stations, collecting stations, portable surgical hospitals, semimobile evacuation 
hospitals, and evacuation hospitals, all of which were included in the troop basis 
of the Army Ground Forces "to assure proper training and indoctrination" in 
support of "ground troops." At overseas air bases, however, theater com- 
manders had been forced to improvise surgical hospitals, field hospitals, and 
evacuation hospitals. This attempt to utilize a "ground unit" to solve a military 
problem of the "air force" the Air Surgeon's Office noted was, from the military 
standpoint, "illogical and wasteful of personnel and equipment." 162 

Correspondence carried out with the theaters during the next weeks, when 
marshalled along side one another, revealed a pattern of medical service which 
was so ineffective as to hamper the efficiency of Air Force combat operations. 
On 6 February 1944 therefore the Air Surgeon submitted to the Commanding 
General, Army Air Forces, a memorandum with supporting documents 
recommending a change in War Department policy to permit the Army Air 
Forces to control its hospital facilities in theaters of operations. 163 Specifically 
it was recommended that the AAF be authorized to operate hospitals at 
Air Forces bases outside the limits of the continental United States; that the 
War Department policy regarding hospitalization outside the continental 
United States be revised to provide hospitals in the Troop Basis as organic 
units of the Air Forces to serve the air bases and Air Force installations outside 
the continental limits of the United States; that adjustments be made in the 
Troop Basis of the Army Service Forces and the AAF in order to accomplish 
this without increasing the over-all Army Troop Basis; and that sick and 
wounded AAF personnel returned from overseas, except the individuals requir- 
ing specialized general hospital care, be sent direct to AAF hospitals. 164 

The reasons advanced for separate hospitalization synthesized the entire 
problem relating to hospitalization, including both overseas and the Zone 
of Interior. It was pointed out that the Air Forces could not hospitalize its 
own personnel overseas, and sick and wounded personnel returned to the 
continental United States must go to general hospitals of the Army; yet to 
carry out responsibility for health of Air Forces personnel, the Command- 
ing General, AAF, must have complete and continuous control of sick and 
wounded AAF personnel. The policy of hospitalizing AAF personnel in 
Service and Ground Forces hospitals, it was believed, resulted in difficulties 
in obtaining records of transferred personnel, lack of control over release and 
return to duty, and unnecessary delays in obtaining reassignments to active 
duty. Moreover, hospitals were often established without regard to Army Air 



THE WAR MISSION 



87 



Forces troop concentrations and medical needs. This situation was impairing 
Air Force operational capacity through loss of a large number of man-days 
of personnel, and creating a serious morale problem among AAF sick and 
wounded. 

On the basis of this recommendation, General Arnold addressed a separate 
memorandum to General Marshall for comment on 16 February 1944, 
submitting a proposed memorandum for the Chief of Staff recommending: 165 

1. That the War Department policy regarding hospitalization outside the continental 
United States be revised to provide hospitals (which are organic units) of the Air Forces 
to serve the air bases and the Air Force installations outside the continental limits of the 
United States, and that adjustments be made in the Troop Basis of the Army Service 
Forces and the AAF in order to accomplish this without increasing the over-all Army 
Troop Basis. 

2. That sick and wounded AAF personnel returned from overseas, except the individ- 
uals requiring specialized general hospital care, will be sent direct to AAF hospitals. 

The reasons he marshalled were impressive. "Every day saved in care and 
rehabilitation of our sick and wounded strengthens our fighting capacity. Every 
man lost from active duty must be replaced." Then he went to the heart of 
the matter. "Our medical policy should therefore be designed to ensure the 
earliest possible return to duty of every sick or wounded man who can be 
rehabilitated." As a matter of courtesy he sent the proposed memorandum 
to General Somervell for comment. On the memorandum are two unidenti- 
fied blue pencilled notes. A reference to the "general hospitals of the Army 
Service Forces" was modified to read "of the Army." A sentence beginning 
with the words "although command responsibility for health of Air Forces per- 
sonnel rests with the Commanding General, AAF," bore the marginal inscrip- 
tion "Not so." It can be speculated as to whether this memorandum may have 
been the final straw which brought the controversy into the open. In any 
event, by 22 February 1944 it had been returned to the Air Surgeon with a 
pencilled note on the bottom of the covering memorandum reading "2/22/44 
Gen. Vandenberg — Hold until we see further developments. HHA." These 
developments were not many hours away. 

Meanwhile the 6 February study was transmitted to the Army Service 
Forces for comment, and apparently prompted The Surgeon General to address 
a memorandum to General Somervell, dated 26 February 1944, summarizing 
the hospitalization plans in effect in the theaters of operation. 166 The burden 
of this memorandum was to the effect that appropriate provisions had been made 
for hospitalization and an appropriate proportion of beds allocated to the Army 
Air Forces. One supporting document included was a copy of a teletype 



88 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



conversation between The Surgeon General and the Surgeon of the European 
Theater of Operations. In answer to specific questions from The Surgeon 
General concerning separate hospitals for the Air Forces, the European Theater 
Surgeon was quoted as saying: "Air Force thoroughly satisfied with hospital- 
ization furnished by SOS at this time. The question of separate hospitals in 
projected operations has never entered the picture. Separate hospitalization is 
not required." 167 

The fundamental issues at stake, however, were not considered. After 
examining the comments, a member of General Arnold's Staff advised him in a 
memorandum that: 168 

The material in no way touches the basic complaint of the Air Surgeon's Office and, I 
believe, of AAF personnel in the Theater, that AAF patients who require hospitalization 
must be transferred to ASF hospitals and station; [sic] that in ASF hospitals they do not 
receive care appropriate to their needs owing to lack of knowledge of specific needs of flying 
and ground personnel; that they are held in hospitals for unduly long periods; and that AAF 
Commands lose control of personnel during hospitalization. 

While the basic issue concerned all theaters of operations it was, ironically, 
the European Theater that was to prove the testing ground, and within a matter 
of days. For even as the European Theater Surgeon was assuring The 
Surgeon General that the situation was satisfactory, complaints had reached the 
White House that American flyers were not receiving care comparable to that 
received by Royal Air Force flyers. These complaints did not emanate from the 
Air Surgeon. Admiral Ross T. Mclntire, White House physician, recalls that 
among others Secretary of War Stimson had expressed concern over the matter 
to the President. The matter may also have been brought to the President's 
attention by his son Elliott, an Air Force officer, or his wife, Mrs. Eleanor Roose- 
velt. 169 As a possible solution, Roosevelt suggested that The Surgeon General 
and the Air Surgeon, together with a "referee" whom the President should 
designate, be sent as a Board to study the problem. Dr. Edward A. Strecker, 
civilian consultant to both the Navy and the AAF was named as the third 
member. 170 Chief of Staff George C. Marshall, through whom the matter 
would normally have been handled, was said in a later conference to have stated 
that he knew nothing of this proposed trip until Roosevelt informed him 
following a normal combat briefing at the White House. He returned to 
his staff offices and held a conference with General Arnold, General Somervell 
and Deputy Chief of Staff J. T. McNarney, who was the ranking aviator on 
General Marshall's staff. The President's order to send Strecker, Kirk and 
Grant to Europe was accomplished within 4 days, but Marshall instructed 



THE WAR MISSION 



89 



Arnold and Somervell that never again was the President to be called in to solve 
any type of controversy between staff officers. 171 

In order to understand the problem area into which the Strecker Board was 
looking in England, it must be recalled that there had been a rapid development 
of general hospitals during 1942 and 1943 but relatively few cases had filtered 
back to United States from overseas. The same situation existed in England. 
Hospitals had been established but the only actual combat cases were Air Force 
crewmen returning from bombing raids over Europe. The net result was an 
actual scramble for patients in the continental United States general hospitals 
and in the overseas theaters. The " 120-day" patient care limitation was disre- 
garded to keep interesting long term patients in overseas hospitals where quali- 
fied professional men would otherwise have had little to do. This decision soon 
led to a deficit of aircrew due to the fact that patients were either held in hos- 
pitals or they were processed in Communication Zones and ground force lines to 
"pools for reassignment," without regard to AAF crew pipe-line procedures. It 
soon became evident that this friction was not only medical in character between 
those assigned to the AAF and U. S. Army but that it had ramifications in the 
field of manpower and aircrew personnel. In rapid order Air Force com- 
manding officers, were talking of aviation medicine and air combat fatigue as 
new concepts — new to them but routine to the flight surgeon. It seemed to be 
a red flag before the medical officers of the Army and particularly those of the 
higher echelon so long imbued with "fixed ideas" of evacuation, triage and 
general hospitals in support of "divisions, corps and armies" in a geographically 
defined combat area. 172 The basic problem confronting the Board, thus, was 
not to evaluate the general hospital system in the United Kingdom — which 
President Roosevelt had referred to as being excellent 173 — but rather to deter- 
mine whether this system, based upon the traditional requirements of the ground 
forces, was providing optimum care to keep the flyer in the air. With the inno- 
vation of the Combined Bomber Offensive in January 1944 as prelude to a cross- 
channel attack, the strain of around-the-clock operations made the aircrew 
problems of health and morale matters of primary significance. 

Upon the arrival of its members, the Board held conferences with both 
General Carl Spaatz, Commanding General of the United States Strategic Air 
Forces, and Lt. Gen. James H. Doolittle, both of whom "expressed their 
opinion that the medical interests of the Air Forces, on account of their highly 
specialized problems, would best be served by a separate medical establishment 
which would care for their needs." 174 This opinion was based upon the 
need for "intimate personal contact between crew members and flight surgeons 



90 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

necessary to keep flyers in the air/' a personal relationship which, under the 
existing system of hospitalization, "was disrupted due to the fact Air Forces 
patients were placed in hospitals not manned by individuals familiar with the 
Air Forces' problems." General Spaatz, it was reported, appeared particularly 
"worried" by the loss of combat crews over target, while General Doolittle 
was concerned about hospitalization when operations of his command got 
under way. 

These conditions were acknowledged in paragraph i of a memorandum for 
the Chief of Staff which carried the signature of Kirk, Grant and Strecker in 
that order. Yet, in paragraph 2, the excellence of the hospital system was 
commented upon. With reference to the location of the hospitals the Board 
reported that in occasional instances hospitals were inconveniently located but 
that this situation existed because of difficulty in obtaining suitable sites and 
because of construction delays. It was noted that medical and surgical care was 
excellent for three reasons: The Theater Surgeon had made available to the Air 
Forces sufficient numbers of fixed hospital beds in station and general hospitals to 
support the Air Forces; there was close cooperation of the Surgeon, USSTAF 
and the Theater Surgeon, and, finally, there were efficient Air Corps dispen- 
saries located on each field. In general, there was excellent team work 
between Air Forces and Army Medical Department personnel although 
the Surgeon, USSTAF was "of the opinion that certain administrative diffi- 
culties occasionally delayed the return of Air Corps patients from general 
hospitals to duty." 

The problem of rehabilitation of combat crew members was believed by 
the Air Force to constitute a special problem and should therefore be handled 
under its jurisdiction; but in view of the "administrative difficulties, shortage 
of personnel and the additional overhead required" the matter was to be left 
to the discretion of the respective surgeons in the theater. It was recommended, 
however, that Air Forces personnel and facilities be made available for train- 
ing and if this did not work out, that "consideration be given to a separate 
installation to carry out rehabilitation in these forces." 

The President having specifically requested that the Board investigate 
reports that RAF flyers received superior care to that given American flyers, 
three RAF installations were visited. It was the opinion of the Board that 
while the caliber of medical and surgical care and facilities for flying personnel 
in station and general hospitals was superior to that given to the Royal Air Force, 
that reconditioning and rehabilitation of flying personnel in the RAF was 
further advanced. 

The various aspects of the situation were thus appraised by The Surgeon 



THE WAR MISSION 



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General, who was on record as opposing separate hospitals for Army Air 
Forces ; by the Air Surgeon who was on record as favoring separate Air Force 
hospitals; and by Dr. Edward Strecker the "umpire." Though the Command- 
ing General, USSTAF, was of the opinion that a separate medical establish- 
ment was desirable, there was an overwhelming consideration which more than 
any other was to determine the recommendations of the Board: the fact that D 
Day was little more than a month away. The Board therefore recommended : 
"In view of the long established system of hospitalization in the ETO and 
contemplated new operations, it is felt that any change in the general principle 
of hospitalization at this time should not be recommended." 175 In the interest 
of expediency therefore the basic problem which lay much deeper than the 
President's query about Royal Air Force versus Army Air Forces crew care 
was to remain temporarily unanswered. In the European Theater the existing 
system would remain, subject to improvements recommended by the Board. 

The Issues Are Partially Resolved: 1944 

On the morning of the take-off of the Strecker party, the orders of one Air 
Force officer, Lt. Col. Richard Meiling, who had been scheduled to accompany 
General Grant, were suspended by General Marshall, who had established an 
ad-hoc Committee and designated him as Air Force member. A general officer 
was selected to represent The Surgeon General. They were instructed to 
prepare a regulation which would resolve the existing friction and yet 
provide adequate medical service for the Army Air Forces. 176 Through the 
next days while the Strecker party visited the European Theater, this committee 
met daily. 

The ad-hoc committee, functioning daily while Generals Kirk and Grant 
were overseas, prepared a directive for their signature immediately upon their 
return. Published as War Department Circular 140 on 11 April 1944, it rep- 
resented another milestone in the development of the Army Air Forces medical 
service, for it clearly assigned to the Army Air Forces certain responsibilities 
which had been the subject of controversy throughout the war period. 

This directive provided that Army personnel be treated in the nearest 
adequate medical facility regardless of command jurisdiction; that duplication 
of hospitals facilities be avoided; that station hospitals normally serve an area 
within a radius of 25 miles and the regional station hospital and general hospital 
an area within a radius of 75 miles; that mutually satisfactory arrangements for 
hospitalization would be made by commanders of the Army Air Forces and the 

262297°— 55 8 



92 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Army Service Forces without duplication of facilities; that patients be trans- 
ferred to the nearest adequate medical installation, regardless of command 
jurisdiction, so that the time lost from duty would be reduced; and that medical 
specialists could be sent to a "hospital to advise as to treatment or transfer of 
the patients." It was also agreed that separate convalescent hospitals could be 
established; and that patients from overseas would be transferred to general hos- 
pitals or to Army Air Forces or Army Service Forces convalescent facilities. 
The need for this had become apparent as increasing numbers of patients began 
to arrive from overseas and the adverse effect of mixing them with patients from 
training bases and centers became manifest. It was clearly necessary to keep 
Army patients of the two groups separate. 

Parenthetically this was a primary reason regional hospitals had come 
into existence in the Army since they provided "general hospital type" 
care for the majority of Army trainees. Almost all of these later became 
true general hospitals as the Army training load dropped off and the load of 
overseas casualties skyrocketed. This splitting of patient flow according to 
whether they were combat or trainee in origin was a new development in World 
War II. But it should be emphasized that while this split was essential for pa- 
tients of Arfriy Ground Forces origin partly because of their numbers, it was not 
essential for the Air Forces. Training accidents were frequent enough that the 
impact of additional casualties from overseas had a negligible effect upon the 
morale of the average Army Air Force hospital patients. 

Thus, there was provision for two new types of AAF hospitals — regional 
station and convalescent hospitals. The regional station hospital was "staffed 
and equipped to provide definitive medical, surgical, and hospital care, except for 
those patients requiring specialized treatment provided for specifically in certain 
named general hospitals." It received patients from an assigned area regardless 
of command jurisdiction. The Commanding General, AAF, was to appoint 
disposition boards, physical reclassification boards, and retirement boards for 
personnel at regional station and convalescent hospitals under his command 
jurisdiction; no personnel of the Army Air Forces would be separated from 
military service by Army Service Forces boards without the concurrence of the 
Commanding General, Army Air Forces, or his representatives. Finally, the 
Commanding General, Army Air Forces, was charged with the responsibility of 
air transportation of patients and with providing the necessary medical person- 
nel required for this function. 177 

This agreement had gone far indeed toward crystallizing the type of medi- 
cal service that could best serve the needs of the Army Air Forces. In summary, 
the basic principle upon which the station hospital system had been built was 



THE WAR MISSION 



93 



reaffirmed, namely, that it would provide medical care within the limits of 
its capability; the concept of the regional hospital to provide specialty care 
was accepted as the keystone to a structure of which the station hospital was the 
cornerstone; it was agreed that the AAF would have proper representation at 
general hospitals; and, once again, the responsibility of the AAF for transport- 
ing the sick and wounded had been reaffirmed. Of the convalescent hospital 
more will be said later. The authority for the regional hospital having been 
granted, it was now necessary to designate the station hospitals in both the Army 
Air Forces and the Army Service Forces which would operate under that title. 
This designation was made by The Surgeon General in collaboration with the 
Air Surgeon, and each group was allotted 30 hospitals which would assume the 
regional function. 178 The list selected was approved and made official by War 
Department Circular No. 228, 7 June 1944. 179 

The regional hospitals provided a great deal of specialized treatment 
though largely for patients of Zone of Interior origin (trainees, as mentioned 
earlier). Also patients from regional hospitals who would never be able to 
return to duty were frequently sent on to the named general hospital for 
specialized care nearest their homes. In short, the regional hospitals served 
as the "General Hospitals" for patients of Zone of Interior origin and it is im- 
portant to bear this relationship in mind. The general hospitals to a large 
extent received only overseas returnees, as previously noted. 

In the spring of 1944, meanwhile, the Professional Division of the Air 
Surgeon's office, directed by CoL fldtil Holbrook, revised the specialist hospital 
staffing guides and set up new ones for station, regional, and convalescent hos- 
pitals in the Zone of Interior for the purpose of further conserving specialist 
medical personnel. These guides were correlated with similar ones by The 
Surgeon General, and later were agreed upon by both the Air Surgeon and 
The Surgeon General as the official manning guides for Army hospitals in the 
Zone of Interior. 180 

Already flight surgeons were on duty at general hospitals and had been 
since the summer of 1943 when The Surgeon General requested that the Air 
Surgeon make available a flight surgeon for duty in the general hospitals in 
which Air Forces combat crews were being hospitalized. 181 Later, provision 
was made for administrative (nonmedical liaison officers from the Army Air 
Forces) to be stationed in the other general hospitals as well as at certain Army 
Service Forces regional hospitals. These officers advised the commanding offi- 
cers of the hospitals in "matters pertaining to disposition, assignment, and 
separation of Air Forces personnel." 182 Flight surgeon consultants now visited 



94 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



both general and certain regional hospitals "for the purpose of conferring with 
hospital authorities on aviation medical matters and to visit rated Army Air 
Forces patients." Implementation of the program now rested with The Com- 
manding General, Army Air Forces Personnel Distribution Command. 183 

In late November 1943 t ' ie AAF had operated 239 station hospitals with 
75,461 beds; 146 dispensaries, 10 beds each; 324 infirmaries; medical service 
provided for 152 civilian Training Detachments and 53 Flying Training De- 
tachments; and 16,000 Medical Department officer personnel were on duty. 184 
As of January 1945, a few months before V-J Day, it controlled 234 hospitals, 
of which 211 were then in operation. The other 23 were either inactive or had 
been reduced to dispensary status. The total bed capacity at 72 square feet was 
73,451, According to types, there were 30 regional, 9 convalescent, and 172 
station hospitals. There were approximately 275 dispensaries, of which about 
15 percent had 10 beds. 185 The bed capacity ranged from 25 to 2,500 with only 
28 of 500 or above. 186 

The policy of The Office of The Surgeon General, as outlined in War 
Department Circular No. 140, 11 April 1944, stipulated that overseas patients 
"be transferred from debarkation hospitals to appropriate general hospitals or 
in appropriate cases to Army Air Forces or Army Service Forces convalescent 
facilities . . 187 When, in the spring of 1945, a serious shortage of beds threat- 
ened the Zone of Interior, this policy became a matter of grave concern to the 
Air Forces which had available beds but could not use them. The matter was 
doubly grave in view of the fact that The Surgeon General proposed, instead, 
to construct new facilities. Colonel Schwichtenberg, the Air Force liaison 
officer who had been also designated as the deputy chief of operations for 
domestic operations and evacuation from overseas under General Bliss in The 
Surgeon General's office, urged and obtained through the latter permission to 
ask the Air Surgeon to survey Air Force hospitals to care for overseas evacuees 
instead of further construction or rehabilitation of Army hospitals. This was 
done because it appeared probable that the influx of overseas patients was 
greater than the expanded general hospital system (actually specialized hos- 
pitals) could accommodate. By a very narrow margin this did not become 
necessary. There was very serious objection to this move and every effort was 
directed toward avoiding this step both because of the principle involved as 
well as the increased administrative problems. 

Originally hospital beds had been authorized at 4 percent of the troop 
strength of the area served, a ratio later reduced to 3.5 percent for station hospi- 
tals although it remained at 4 percent for regional hospitals. 188 However, 



THE WAR MISSION 



95 



proceedings were initiated by the Office of the Air Surgeon as early as 16 
October 1943 to reduce all hospital facilities not actually needed, and on this 
date Lt. CoL Lee C. Gammil, Chief of the Hospital Construction Section of 
the Air Surgeon's office, recommended, on the basis of a survey made of each 
Army Air Forces hospital as of 15 September 1943, that the number of beds be 
reduced by 7,131 by (1) closing hospitals not needed; (2) reducing certain hos- 
pitals to dispensary status if another hospital is in the same area; and (3) making 
bed ratings conform "to troop strength and bed occupancy percentage require- 
ments." 189 Therefore, the move to reduce hospital facilities under the control 
of the Air Forces was initiated well in advance of the publication of Circular 
No. 140 of 11 April 1944, which was designed to prevent duplication of hospital 
facilities. 

There were no data from September 1944 to December 1944 to indicate 
future shortage of hospital beds in the Zone of Interior; but, to the contrary, all 
current information and past experience indicated that there was a surplus of 
hospital facilities, a fact which led to repeated efforts by the War Department to 
force The Surgeon General to reduce these facilities. WDGS G-4 stated that 
the number of beds in station and regional hospitals in the Zone of Interior was 
in excess of authorized allowances and directed that plans be prepared by 
1 November 1944 for reductions. 190 In compliance, the Director of Plans and 
Operations, Army Service Forces, on that same day, 23 September 1944, prepared 
a memorandum to The Surgeon General, for the signature of The Command- 
ing General, ASF, in which it was directed that station hospital facilities be 
reduced to 3 percent of troop strength and general hospital facilities be reduced 
to 100,000 beds. 191 In substantiating this position, attention was called to these 
facts: 192 A study of the Zone of Interior hospitals showed that only 50 percent 
of their capacity had ever been utilized; that 3 months after D Day the occu- 
pancy of general hospital facilities was only 48 percent, representing a total 
increase of 6,000 patients during this period; and that, although The Surgeon 
General expressed the opinion that the general hospital capacity of the Zone of 
Interior would be inadequate to care for the patients by the end of 1944, he 
failed to make allowance for the expansion capacity of the hospitals, and his 
original estimate of 166,000 patients in the European theater was far wide of 
the mark of the actual number of 90,000 patients as of 5 September 1944. 193 

As a result, bed authorizations were ultimately reduced to 3.5 percent of the 
average personnel strength served for station hospitals and 0.5 percent for 
regional hospitals. 194 In order to see that the reductions were actually made, 
The Surgeon General was directed to make weekly reports to the Director of 
Plans and Operations, Army Service Forces, showing reductions accomplished. 195 




1 hosprfoK— AAF m S ton*\ ifotion hospital,, AAF convalesced hospitals. 



96 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



The Assistant Chief of Staff, G-4 was of the opinion that a further reduction in 
hospital facilities for the Zone of Interior should be authorized, and directed 
that a plan be submitted which would effect an additional 25-percent reduc- 
tion. 198 The Surgeon General, however, countered his directive with data from 
a study made by his office, showing that winter occupancy of station hospitals 
beds for the past 4 years had averaged 2.7 percent of the strength served; and that 
allowing 20 percent for dispersion, the minimum ratio would be 3.375 percent, 
which, it was thought, was close enough to the current authorized strength of 
3.5 percent of the strength served. 197 

In November 1944 WDGS G-4 directed the Commanding Generals of the 
Army Services Forces and the Army Air Forces that, pending changes in exist- 
ing Army Regulations and War Department Circulars, station hospital beds be 
reduced to 3 percent of the average strength served; that regional hospital beds 
remain at 0.5 percent; that the basis for general hospital beds remain at 1 percent 
of the strength of the Army plus 0.7 percent for oversea strength, which basis 
provided for 114,000 general hospital beds at this time; and that on or before 
15 January 1945 a report be made on Zone of Interior hospitalization based on 
actual experience. 198 On 7 December 1944 The Surgeon General was advised 
by the Acting Director of Plans and Operations, Army Service Forces, to put 
these reductions into effect without further delay. 199 

On the basis of the experience of the past 3 years and the accepted War 
Department evaluation of the future course of the war in Europe after the 
Normandy Landings, the Assistant Chief of Staff, G-4, was probably correct 
in his insistence that hospital facilities in the Zone of Interior station and 
regional hospitals be reduced. Because little professional work was available 
for the large number of skilled hospital staff available in England during the 
buildup period and even after Normandy to some extent, ETO hospitals got 
into the habit of retaining patients for definitive treatment who should have 
been, and were planned to be, returned to the Zone of Interior. The load 
increased until the Battle of the Bulge when most hospitals were full. There 
was no room for additional combat casualties many of whom were airlifted 
from forward areas and it was at this time that patients appeared at Mitchel Field 
from overseas within 72 hours of the time they were wounded and with original 
battle dressings in place. This also pointed up for the first time the possibilities 
of air evacuation in place of a large hospital establishment overseas. Thus part 
of the Zone of Interior low general hospital occupancy rate was due to the failure 
of the Surgeon, ETO, to have returned to the Zone of Interior patients requiring 
long-term definitive care. Actually, therefore, G-4 was in error, as subsequent 
events only a matter of weeks away were to prove. Also the presentation of 



THE WAR MISSION 



97 



hospital beds requirements Zone of Interior made by the Office of The Surgeon 
General in September or early October 1944 and prepared by a Dr. Ginsberg on 
his staff were correct to less than Y 2 percent error. 

The later course of the war after the Battle of the Bulge in late 1944 
rendered current hospital plans obsolete*. With a spring offensive in the off- 
ing, it was planned that accumulated patients would be removed from the hos- 
pitals in the European Theater as rapidly as possible to make room in these 
hospitals for expected casualties. Obviously this plan would overtax the Zone 
of Interior facilities, and therefore reassessment of the Zone of Interior hospital 
facilities had to be made in the light of new and increased demands. On 4 
January 1945, The Surgeon General submitted estimates of the general and 
convalescent hospital patient load for the current year, along with a statement 
of the number of such beds available. 200 It was anticipated that 203,000 general 
and convalescent beds and 14,000 additional beds for debarkation purposes 
would be needed to handle the peak load of patients, including an expanded 
sick leave and furlough policy. Since there were at this time only 119,000 
general hospital beds and 30,000 convalescent beds, a deficit of 68,000 hospital 
beds existed. It was anticipated at this time also that a marked expansion of 
the sick leave and furlough policy would be desirable for patients as well as a 
means to cover peak periods. This was instituted by The Surgeon General's 
Office over the often strong protests of the hospital commanding officer. It 
did work well in practice, however, and eliminated the necessity for construction 
or rehabilitation of thousands of hospital beds. To make this program effective 
hospitals were overfilled by the medical regulating office working under the 
direction of the Operations Division, The Surgeon General's Office, thereby 
forcing hospital commanders to grant sick leave and furloughs to patients who 
could profit from them. Thus it came to be realized that in a strong medical 
regulating office The Surgeon General had an ideal method of control over the 
patient flow through the general hospital system. His Operations Division 
controlled the extent of overfilling of the hospitals by frequent flying visits 
with the professional consultants to sample general hospitals; the percentage of 
overfilling thus determined to be feasible was imposed on the hospitals through 
the Medical Regulating Office. 

Immediate action was initiated to obtain authorization for the new beds. 
The Surgeon General recommended that an additional 50,000 general hospital 
beds and 20,500 convalescent hospital beds be provided. 201 This recommen- 
dation was concurred in by the Commanding General, Army Service Forces, 
and approved by the War Department on 20 January 1945, subject to final 
approval of the President. 202 A memorandum for the Chief of Engineers dated 



THE WAR MISSION 



99 






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100 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



22 January 1945 from the Director of Plans and Operations, Army Service 
Forces, outlined the plans to be used in providing the beds for the expansion 
program. A copy of this memorandum was attached as an inclosure to a 
memorandum of the same date to The Surgeon General. 203 In this memo- 
randum The Surgeon General was advised to "collaborate with the Chief of 
Engineers and recommend only the minimum of essential conversion, giving 
due consideration to the fact that the authorized facilities are provided to handle 
the peak load and some of them will be used for a very short time." 204 In 
addition, The Surgeon General was directed to restudy the facilities of the 
station and regional hospitals with the view of effecting an economy in medical 
personnel to compensate in part for the increased personnel required for the 
expansion program. 205 

The urgency of the hospital situation as described by The Surgeon General 
prompted G-4 to determine if all facilities available were being used. In 
pursuing this idea, G-4 directed the Commanding General, Army Air Forces, 
to determine the type and number of oversea returnee patients who could be 
adequately cared for with existing facilities, with increased personnel. 200 After 
a survey of Air Forces regional hospital facilities was made, the Air Surgeon 
reported to G-4 that, with the present facilities and personnel, 4,000 oversea 
casualties could be properly cared for at the rate of 1,000 weekly, in the categories 
he indicated; if the enlisted strength of these hospitals were brought up to the 
authorized strength, 6,500 casualties could be cared for; with augmented per- 
sonnel and existing facilities, 10,350 could be admitted; and with conversion 
of existing barracks and further augmentation of personnel, a total of 14,800 
casualties could be admitted. 207 

The representatives of The Surgeon General's Office and the Air Surgeon's 
Office met on 23 February 1945 with the President's Hospital Board for the 
purpose of considering The Surgeon General's request for an additional 70,000 
hospital beds, the construction of which had already begun without approval 
of this board. Representatives of The Surgeon General described the situation 
as desperate, saying that more patients were arriving than could be handled 
by available beds, and that the need for beds would become increasingly acute. 
The president of the board made inquiry as to whether or not consideration 
had been given to the use of the Air Forces regional hospital facilities. The 
answer was in the affirmative but it was added that the available AAF beds 
would be insignificant in comparison with over-all needs. 208 On the next day 
after this conference was held G-4 received a nonconcurring indorsement to 
the Air Forces study offering the use of 10,300 beds during the emergency. 209 

In a memorandum for the Commanding General, Army Service Forces, 



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101 



and Army Ground Forces, G-4 called attention to the existing facilities of the 
Air Forces which would provide immediate hospitalization for approximately 
4,000 selected types of cases in the regional hospitals. The Surgeon General 
and the Air Surgeon were directed to devise an effective method of assigning 
the casualties to these hospitals. The Surgeon General, who ordinarily con- 
trolled the hospitalization of oversea returnee casualties, was reassured that: 
"This action does not alter current policies on hospitalization but is an emergency 
measure taken to provide hospital care during the period when evacuation is 
heaviest." 210 On the morning of 2 March the Air Surgeon met with medical 
regulating officers of the Army Service Forces and the Army Air Forces to dis- 
cuss procedures, 211 but in the afternoon the representative of the ASF Medical 
Regulating Office advised that his office could not participate in checking and 
coding 224 patients who were being taken from Mitchel Field Air Debarkation 
Hospital and admitted to Air Forces regional hospitals. He offered two reasons 
for his nonconcurrence: He understood that among the patients to be transferred 
were some who were classified in the categories of General Surgery, Ortho- 
pedics, and General Medicine, a plan to which he was opposed, and that he had 
received no instructions from his superior officers to coordinate the transfer of 
the patients to the Air Forces regional hospitals. 212 On the following day at a 
conference attended by Brig. Gen. W. J. Morrissey, Acting Assistant Chief of 
Staff, G-4, reaffirmed the previous memorandum directing that the Army Air 
Forces regional hospital beds be utilized, and added that unless all existing 
facilities were used, G-4 could not support the 70,000 additional hospital bed 
requirement before the Federal Board of Hospitalization. He further advisee 
that the original directive became effective on the date of signature 213 

The Surgeon General, however, continued to adhere to his thesis that the 
Air Forces regional hospital facilities were not now needed and remained 
firm in his refusal to permit oversea returnee patients to be admitted to these 
hospitals. In the meantime, rehabilitation of medical and other facilities to 
provide new beds was being rushed. Taking cognizance of the impasse, the 
Air Surgeon addressed a memorandum to G-4 asking for clarification of the 
situation, and for advice as to when patients could be expected. 214 In answer, 
G-4 stated that the disagreement over the necessity for the use of the Air Forces 
regional hospitals had been referred to the Deputy Chief of Staff, who had 
ordered The Inspector General to make a survey of the entire Zone of Interior 
hospitalization program, and that no overseas patients could be admitted to 
the Air Forces regional hospitals pending the completion of this study. 216 This 
survey was made and a report rendered on 14 May I945- 216 While the report 
dealt with the entire Zone of Interior hospitalization policy, only that part 



102 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



which deals with the regional hospitals is significant at this point, although 
it is of interest to note that the report stated that "as reflected in this report, 
maximum utilization of hospitalization personnel and facilities in the Zone of 
Interior has not been made." 217 

In reference to AAF regional hospitals, The Inspector General stated : 218 

/. That regional hospitals, both AAF and ASF, are adequately staffed with profes- 
sional personnel and adequately equipped to properly care for oversea patients, excepting 
those patients requiring specialized definitive treatment of a type afforded only by certain 
general hospitals. 

g. That utilization should be made of regional hospitals to hospitalize oversea patients, 
in order to relieve partially the present and projected heavy patient load in general hospitals 
and to provide hospital assignments for patients in areas nearest their homes, particularly 
for those whose homes are in critical areas. 

The Assistant Chief of Staff, G-4, prepared a directive for the Com- 
manding General, Army Service Forces, which would force compliance with 
the recommendations of The Inspector General's report, and sent it through 
channels to the Secretary of War for decision. The Secretary of War returned 
it to G-4 on 20 June 1945 without action. 219 

In connection with the convalescent hospital program, special mention 
must be made of the convalescent training and rehabilitation program per se. 
Conceived by Col. Howard A. Rusk (MC) when stationed in the Army Hos- 
pital at Jefferson Barracks, Mo., this important phase of medical care was pio- 
neered by him in the AAF under Air Surgeon Grant. The primary aim of 
the program, initiated in December 1942, was to retrain soldiers for return to 
military duty. Secondarily, it provided a basis for vocational guidance to 
soldiers making the transition from military to civilian life. It was successfully 
demonstrated that patient morale improved, that hospital readmissions were 
reduced because men were sent back to duty in better physical condition, and 
that the period of convalescence in certain instances was shortened, thus re- 
ducing man-days lost from illness. 

While the publication of Circular 140 had defined the responsibilities of the 
Army Air Forces for carrying out its medical service in the Zone of Interior, 
and permitted the staff to perform elective surgery within the limit of its capa- 
bility, it did not, however, authorize the Army Air Forces to operate any type 
of overseas medical facility larger than the 25-bed medical dispensary. In 
certain overseas areas general hospitals had been assigned for Air Forces use, 
but this did not involve Air Force control. The situation was such, as a matter 
of fact, that flight surgeons could visit Air Force patients only during visiting 
hours and then in a personal rather than a professional capacity. Despite the 



THE WAR MISSION 



103 



fact that General Marshall had given instructions that the matter of hospitaliza- 
tion was not to be considered further at this time, the further fact remained that 
the clamor of complaint from the theater mounted each day. Air surgeons, 
while recognizing that for the time being nothing could be done, did neverthe- 
less register their protests. 

On the basis of questionnaires sent to the theaters in the spring of 1944, it 
was possible to make the first systematic study of the problems involved. From 
every major theater and from every Air Force came statements to substantiate 
the Army Air Forces' position that the major force should control the medical 
policies of its personnel including control of hospitalization facilities. Com- 
ments ranged from disposition policies, morale factors, the problem of an air 
theater, the administrative problem of records, liaison and loss of man-days. 
For example, Maj. Gen. Ennis C. Whitehead, Commanding General of the 
Fifth Air Force, stated that "Two years experience in this theater has demon- 
strated conclusively the need for assignment of hospitals to Air Force." He 
pointed specifically to the fact that disposition of flying personnel from gen- 
eral hospitals was "a discouraging tangle of misunderstanding." In the Seventh 
Air Force it was noted that final disposition of patients in general hospitals 
was unsatisfactory because final action was delayed due to cumbersome SOS 
administrative channels, and because disposition verdicts were "not always 
as intelligent as if flight surgeons had made them," with instances cited. In 
the Eighth and Ninth Air Forces the present policies whereby only SOS surgeons 
could determine whether AAF personnel could be discharged from duty 
and whether this disposition was to duty or to the Zone of Interior was no 
more satisfactory than in the Pacific. The recent assignment to remedy 
the situation by furnishing flight surgeon advisers to each general hospital 
was described as a "rather complicated and unwieldy system" which had an 
added disadvantage because he acted only in an advisory capacity. In one 
instance, a group of 65 malaria cases had spent an average of 3 months in a con- 
valescent center following their hospital therapy ; approximately 50 percent had 
not been returned to flying duty; of the 50 percent returned, there would be 
inevitable relapses when the personnel started to fly at altitudes. This situation 
was the result of the fact that rehabilitation was geared toward return to the 
infantry and physical rehabilitation did not always mean technical rehabilitation. 

The lack of appreciation on the part of SOS disposition boards of the 
problem of combat flying was indicated by the fact that patients were fre- 
quently returned to duty with the recommendation that they be placed on "light 
duty" although there was no light duty in combat flying. Again, there was an 
unrealistic approach to the environmental problems faced. A patient in the 



104 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Tenth Air Force was returned from a general hospital with a diagnosis of ulcer 
and instructed to stay on a special diet of milk and cream. But in the Assam 
Valley in India, unfortunately, "milk and cream were items present only in the 
memories of the personnel." In the Mediterranean Theater, from the Fifteenth 
Air Force came the statement that "Arbitrary ruling by an ASF Surgeon that 
the Air Force personnel are fit for duty . . . has been a handicap," and the 
Twelfth Air Force reported that "In many instances AAF personnel are 
returned to duty which we feel cannot perform any duties with the Air Force." 
In the Fourteenth Air Force the situation was regarded as "outstandingly unsat- 
isfactory." It was noted that China was primarily an air theater and as such 
had been "almost ignored" in the matter of hospitalization. There, 94 percent 
of the AAF bases were over 50 miles from a hospital — bases having an average 
strength of 3,250 men and officers. 

The evidence moreover pointed overwhelmingly to the lack of appreciation 
on the part of disposition boards composed of ground officers to appreciate the 
fact that technical rehabilitation of Air Force personnel must be measured in 
terms other than those for physical rehabilitation. On the one hand, unneces- 
sary time could be lost in trying to rehabilitate cases which would never be fit 
for duty; on the other hand, cases could be returned too soon to flying status 
which involved coping with aeromedical problems of altitude and combat 
fatigue. And from every theater came the unanimous opinion that the morale 
and esprit de corps of Air Force units would be improved if the hospitalization 
were under the control of the AAF. Typical of the reaction was that of the 
Commanding General, Fifth Air Force, who stated that "AAF personnel 
emphatically, desire to be hospitalized and treated by AAF medical personnel." 

Out of this first systematic treatment of the problems surrounding overseas 
hospitalization policies came overwhelming evidence that valuable man-days 
were constantly being lost because of the administrative procedures involved. 
The Fifth Air Force noted that 90 percent of its hospital cases were for short 
periods of time and when transferred to SOS hospitals involved transportation 
problems, transfer proceedings, and travel time which could be largely elimi- 
nated if patients were under the continuous control of the Air Forces. In the 
Sixth Air Force it was estimated that there would be 10 percent saving of man- 
days if the Air Forces operated its hospitals. In the Mediterranean Theater 
(Twelfth and Fifteenth Air Forces) it was estimated that the saving in 
man-days would run as high as 30 percent. 220 As a result of these findings, 
further study was initiated to determine more accurately the exact number 
of man-days in all theaters that might accrue if the AAF exerted control in 
overseas theaters comparable to that in the Zone of Interior. 221 



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Meanwhile, the dream of planes capable of traveling at high altitudes and 
great speed to carry the offensive to the enemy had become a reality with the 
advent of the B-29. During the summer of 1943 the Very Long Range Bomber 
(VH) Program was being organized under the direction of Brig. Gen. Ira K. 
Wolfe as an independent project under the Commanding General, Army Air 
Forces. During the fall and winter of 1943-44 training activities were centered 
under the Second Air Force, and in February 1944 the Advance Echelon 
of the XX Bomber Command departed for India. It was contemplated that 
B-29's based in India and staging through China, would carry the offensive 
to the mainland of China. A second Wing was to follow shortly. In April 
1944 final plans for the organizational structure crystallized with the establish- 
ment of the Twentieth Air Force which called for a Washington Headquarters 
with the Commanding General, AAF, also serving as Commanding General, 
Twentieth Air Force; for a first striking force based in India to stage through 
China; and for a second force to operate from the Marianas. Components of 
the Twentieth Air Force besides the Commanding General, Twentieth Air 
Force, included a Deputy Commander, Administrative, at Hickam Field, T. H.; 
a Deputy Commander, Twentieth Air Force, India-Burma-China, Kharagpur, 
India ; and the Commanding General, XX Bomber Command, Guam. The Air 
Surgeon, General Grant, was to serve as first Air Surgeon, Twentieth Air Force, 
with Lt. Col. Richard L. Meiling as Assistant Surgeon. 

From the medical viewpoint the organizational, administrative, operational 
and logistical aspects of providing medical service for the first global air force 
were to prove nearly as overwhelming as had the medical implications of the 
B-29 program. If the concept of strategic bombing were accepted, medical 
requirements for sustaining crew efficiency for very long range operations would 
have to be re-evaluated on the basis of new logistical factors. Time, space, and 
geography could well be rendered obsolete to a force controlled in Washington 
with one component based in India but staging through China, and a second 
based in the Pacific, both aiming at strategic objectives on the Japanese main- 
land. But yet to be overcome was the problem of how to carry supplies, in- 
cluding medical, over a 12,000 mile supply line from the United States to India, 
and thence by airlift across the formidable Hump to China in support of the 
striking force. There remained also the problem of how best to provide medical 
care for the sick and wounded to encompass emergency, routine and definitive 
care, and to include evacuation of the sick and wounded over routes that 
measured conversely the distance of the supply lines. 

This command structure permitted the Army Air Forces to carry out its 
combat mission as an integrated air weapons system without reference to tradi- 



106 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

tional geographical boundaries which were considered necessary to administer 
massed surface forces. In the spring of 1944 the necessary structure of tactical 
air forces and their services was under study with a view toward providing 
flexibility and mobility in performing the combat mission. It will be recalled 
that in 1940-41 GHQ Headquarters had developed T/O & E's for the ground 
forces, including medical. The traditional system of evacuation and hospitali- 
zation would be used to link field medical service in the Combat Zone with that 
provided by the Services of Supply in the Communications Zone, There had 
not been a comparable development of T/O & E's to support the combat mission 
of the Army Air Forces. Now in the spring and summer of 1944 Air Force 
planners were confronted with the problem. 

On 10 June 1944 the Acting Chief of the Operations Division, TAS, crystal- 
lized Air Force thinking in the realm of medical service for (Integrated) 
Tactical Air Forces. He pointed out that although tactical doctrine and organi- 
zation of the American Army Forces was "markedly altered" with the War 
Department reorganization of March 1942, and although the AAF was at that 
time assigned a definite tactical combat mission, the War Department had not 
yet provided an adequate and efficient medical service, including hospitalization, 
to support the tactical air forces during combat operations. To meet this 
requirement, the Army Air Forces proposed that T/O & E's be established for a 
proposed AAF Wing Hospital (400 beds) and a proposed AAF Air Force 
hospital of 1,000 beds. It was pointed out that each American infantry divi- 
sion was supported by a 400-bed evacuation hospital (T/O 8-581); that the 
strength of the proposed combat wings was approximately twice the troop of 
the current American infantry division; and that it would appear logical that 
the War Department provide a 400-bed AAF wing hospital for each AAF 
combat wing, of approximately 16,000 troop strength. It was contemplated that 
in addition to the 400-bed AAF wing hospital that each AAF General Depot 
(Wing Depot Hqs) would also be equipped with one "Air Base Group Aid 
Station" (12 beds plus 24 expansion beds) and medical personnel to staff this 
dispensary at its 36-bed capacity. Medical officers assigned to the Depot Repair 
Group and the Depot Supply Group would be utilized in staffing this dispensary. 
It was further contemplated that each tactical group would function with one 
service group; that the tactical group headquarters, tactical squadron, and service 
group headquarters would staff the Air Base Group Air Station (dispensary) of 
this service group. The tactical group surgeon would be the Chief Medical 
Officer for both the tactical and the service group. Since the entire medical 
service found in the AAF would be administered by the AAF Wing Surgeon, 
personnel from the tactical groups, service groups, general or wing depots could 



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be attached to the AAF wing hospital as required thus reducing the medical 
personnel required and at the same time, providing an efficient medical service 
capable of meeting the aeromedical problem, as well as the clinical problem of 
the patients. Ten ambulances per wing were to be authorized. The 1,000- 
bed hospital would receive patients evacuated from AAF wing hospitals of an 
Air Force operating in a theater of operations "and would also receive patients 
from Naval and Military forces that might be operating in the adjacent area with 
Air Force in carrying out a specific tactical operation assignment." This hos- 
pital would be similar to the Navy "Fleet Hospital 1,000 beds" and Army Serv- 
ices General Hospital, T/O 8-550. It was emphasized that experience in the 
various theaters of operations had demonstrated that the present policy of hos- 
pitalizing patients in SOS "fixed hospitals" had resulted in "unnecessary loss of 
man-days due to travel time between AAF installations and SOS hospitals, the 
time loss awaiting action of the hospital disposition boards, and the processing 
required to return patients to a duty station." 222 There the matter rested. 

The problem of determining the structure of the medical component to 
support the major force mission was obviously a matter of pressing concern. 
Never before had the logistics of air warfare been such a dominant factor as 
now when the Commanding General of the Twentieth Air Force, with his 
Headquarters in Washington, D. C, directed the operations of forces half way 
across the world. The Air Surgeon, General Grant, however, found himself in 
an extremely delicate position. On the one hand, as Twentieth Air Force 
Surgeon, he had major responsibility for determining the medical service 
requirements for the Very Long Range Bomber Program. In view of the recent 
findings on the problem of overseas hospitalization for tactical air forces already 
in combat, he could not recommend that the existing system be used for the 
XX Bomber Command, where more than ever before aviation medicine special- 
ists were needed to cope with the problems of high altitude and of stress, and 
where administrative problems of hospitalization and disposition must be viewed 
strictly in terms of aeromedicine. On the other hand, the Commanding Gen- 
eral, AAF, had been unequivocally directed by General Marshall after the 
Strecker visit that there would be no further mention of separate hospitaliza- 
tion in overseas theaters. 

While General Grant's immediate concern in June 1944 was to determine 
the medical requirements of the XX Bomber Command, in his recommenda- 
tions he nevertheless focused again upon the basic problem of overseas hospitali- 
zation to develop the principle of a separate system. In late June 1944 he sub- 
mitted a memorandum for the Chief of Staff which emphasized the "very diffi- 
cult situation" regarding hospitalization which the Air Force found itself in, 



262297°— 55 



108 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



and noted that the situation "instead of improving, is becoming increasingly 
difficult as time goes on." This situation, he emphasized, must be corrected if 
the Air Forces were "to provide adequate and efficient medical facilities, includ- 
ing hospitalization, to meet the daily aeromedical and clinical problem of the 
AAF personnel within the various theaters of operations." At this time he 
chose also to move into unexplored territory— the post-war period. 223 

The Post War Air Force plan [he wrote] must provide for a medical service. The 
question arises shall this be an AAF Medical Service capable of providing for the clinical 
and aero-medical problems of the Air Force and under the jurisdiction of the Commanding 
General of the Air Forces, or shall it be a Centralized Medical Service furnished and 
controlled by the Director of Supply. 

To meet the problem, the Air Surgeon called for the full and unanimous sup- 
port of the Air Staff to bring the matter in its full significance to the attention of 
General Arnold and to suggest that he take it up with the Chief of Staff. 

The Air Staff was divided in its opinion as to whether the Army Air Forces 
should press for hospitals for only the XX Bomber Command or for all theaters 
of operation. OC&R (Operations, Commitments and Requirements) which 
had supported the Grant recommendations that the War Department recognize 
the Air Force responsibility for overseas hospitalization, had shortly to modify 
its position as the full significance of General Marshall's ultimation was realized. 
On ii }uly 1944 Brig. Gen. Patrick N. Timberlake (USA), Deputy Chief 
of Staff, noted that General Giles had informed him verbally that while "Gen- 
eral Marshall is opposed to duplicate medical services/' a staff study should 
nevertheless be prepared for General Arnold. 2 " 4 On 23 July 1944 the Air 
Surgeon transmitted the study to the Air Staff supported by the findings of the 
recent survey of all the theaters; on 27 July at the Twentieth Air Force staff 
meeting, however, General Arnold stipulated that "effort be directed to secure 
hospitalization and reviewing authority of disposition boards for the XX Bomber 
Command onlyT 225 Five days later the study was returned with the statement 
that General Arnold had directed that "the Air Forces will adopt, at this time, a 
policy of requesting control over hospitalization of the XX Bomber Command 
only." 226 

A modified study, providing for hospitalization for the XX Bomber Com- 
mand only, but including illustrative information from the recent survey, was 
resubmitted on 3 August 1944. The basic principles defended in the earlier 
study were unchanged, but were given specific application in terms of the China- 
Burma-India Theater where the XX Bomber Command was based. Again it 
was returned with the recommendation that "great care be taken in the wording 



THE WAR MISSION 



109 



to avoid unsubstantiated criticism of the present system and to avoid antago- 
nizing the 'jury' — in this case the Chief of Staff." 227 

A third draft was submitted by the Air Surgeon on 23 August 1944. There 
was by this time ample evidence that the situation was not satisfactory in the 
XX Bomber Command. Only a few days earlier, on 19 July 1944, Brig. Gen. 
Laverne Saunders, Commanding General, XX Bomber Command, had stated in 
a teletype message that one of the major problems of his organization had been 
to procure adequate hospital facilities to meet the requirements of the XX 
Bomber Command since it arrived there in February and March 1944. Detail- 
ing his problem at great length, he stated that 5 months experience had demon- 
strated that hospitalization to support the XX Bomber Command Project was 
not satisfactory; that evacuation of AAF personnel through SOS channels 
offered no assurance that such personnel would be disposed of to the best 
interests of the Air Forces; and that transfer of patients to the 112th Station Hos- 
pital (which acted as a general hospital) resulted in the loss of training VLR 
personnel. He recommended, among other things, that all hospitals in support 
of the XX Bomber Command be placed under AAF control and assigned to 
the XX Bomber Command for operation. 228 These recommendations, coupled 
with those made earlier for authorization of approximate T/O & E's to provide 
integrated services for the tactical Air Forces, 229 could have formed the blueprint 
for the Twentieth Air Force medical service or for any command that might 
ultimately form a part of the air weapons system. The time, however, was not 
auspicious; and General Arnold apparently recognized that he could press no 
further than he had in view of General Marshall's admonitions. The third 
study was disapproved by him on 1 September 1944. 280 The XX Bomber Com- 
mand was therefore never to control any medical facilities larger than the avia- 
tion medical dispensary, despite reports that came back from the theater through 
the fall and winter of 1944 and on into the following spring; nor did the XXI 
Bomber Command, which was based in the Marianas. The Twentieth Air 
Force did, however, become the authorized agency to handle disposition of 
flying personnel. This marked another milestone in the evolution of an efficient 
medical service to support the Air Force combat mission. 

Paralleling this development was a similar one which took place in the Air 
Transport Command. When, in the previous August 1943, the Operations Divi- 
sion of the General Staff (OPD) directed the transfer of Harmon Field and 
Gander Lake (Newfoundland Airport) from the Commanding General, New- 
foundland Base Command, to the Commanding Officer, North Atlantic Wing, 
Air Transport Command, 231 the transfer of the 319th and 311th Station Hos- 
pitals was held in abeyance until the following March pending decision as 



110 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



to whether it was possible to assign these hospitals to the Army Air Forces. 232 
When the Organization and Training Division, G-3, contacted a representative 
of the Office of The Surgeon General concerning the possible transfer of the 
hospitals he was advised that, under present War Department policy, no station 
hospitals could be transferred to the Air Transport Command, since overseas 
fixed hospitalization was the responsibility of the Army Service Forces. 233 
G-3, in the same communication, requested that the Commanding General, 
Army Air Forces, submit for consideration recommendations relating to 
"requirements for hospitalization or medical services which must be furnished 
by units not under the control of the North Atlantic Wing, Air Transport 
Command." 234 While the Air Forces did not during the war period operate 
overseas medical facilities larger than the aviation medical dispensaries, the Air 
Transport Command was to come very close to operating its dispensaries as 
station hospitals. 

Concerning medical services for the bases in question, Col. T. L. Mosley, 
Assistant Chief of Air Staff, Operations, Commitments and Requirements, 
advised that a tentative agreement had been reached by The Surgeon General 
and the Air Surgeon with respect to the 310th and 311th Station Hospitals; 
that according to this agreement the personnel, equipment, and funds of these 
hospitals would be transferred from the Army Service Forces to the Army Air 
Forces without release of the names and numbers of the hospitals; and that 
station hospital numbers were to be retained by Army Service Forces and 
returned to the United States. After this change became effective, the Com- 
manding General, Air Transport Command, North Atlantic Wing, would 
assume responsibility for the medical installations at the fields. 23. It was 
requested, however, that War Department approval of this plan be delayed 
until the Manning Table for the North Atlantic Wing, Air Transport Com- 
mand, was submitted so that the effect of the change in the Army Air Forces 
Troop Basis could be determined. 236 When G-3 asked if the statement of the 
agreement between The Surgeon General and the Air Surgeon concerning 
the hospitals in question was meant to infer that the Army Service Forces had 
agreed to accept the necessary reduction in its Troop Basis in order to establish 
this hospitalization in the Army Air Forces Troop Basis, 237 it developed that 
the problem had not been discussed; however, it was promised that the addi- 
tional total strength of 203 individuals required to operate the five hospitals 
be absorbed within the current Air Transport Command allotment. 238 

In accordance with directions issued by OPD, The Adjutant General pre- 
pared a letter, dated 11 May 1944, transferring units and personnel of these 
hospitals to the Air Forces. 239 According to the transfer terms, the Command- 



THE WAR MISSION 



111 



ing General, AAF, was directed to include the transferred personnel within the 
allotment of the North Atlantic Wing, Air Transport Command, and to furnish 
medical service for the stations from which the ASF units were withdrawn. 
G-3, acting on the Disposition Form, dated 26 April 1944, from the Assistant 
Chief of Air Staff, announced on 19 May 1944 that "The responsibility of fixed 
hospitalization of all Air Transport personneLunder the North Atlantic Wing 
in Canada and Newfoundland is transferred to the control of the Commanding 
General, Army Air Forces." 240 

Maj. Gen. Leroy Lutes, Director, Plans and Operations, ASF, immediately 
called to the attention of The Surgeon General the action of the War Depart- 
ment transferring the responsibility for fixed hospitalization of Air Transport 
Command personnel under the North Atlantic Wing to the Army Air Forces. 241 
Previously he had asked The Surgeon General to submit comments and recom- 
mendations to serve as a basis for further action by his headquarters. 242 

The Surgeon General stated that he had not been consulted prior to the 
decision of the War Department concerning the transfer of the hospital units, 
that the plan of having one agency responsible for overseas hospitalization was 
sound and should not be altered, and that if the units in question were to be 
returned to the United States they should come at full Table of Organization 
strength. It was recommended that the War Department reconsider its action 
concerning this matter. 243 General Lutes incorporated the statements of The 
Surgeon General into a memorandum to G-3 in which he asked for reconsidera- 
tion of the decision transferring the hospital units along the North Atlantic 
Wing of the Air Transport Command to the Commanding General, Army Air 
Forces. 244 

Apparently, however, G-3 was convinced that the reasons given by the 
Air Forces for the control of these installations were valid. In addition to the 
fact that the Air Transport Command was the principal using agency of medical 
services at these bases— almost 100 per cent — it was charged by the Air Forces, 
that, under Army Service Forces control, there was a divided responsibility 
between the air base commander and the Services of Supply headquarters in 
the theater with respect to the hospital. Moreover, it was difficult to get infor- 
mation concerning the health of the command, since reports were routed through 
Services of Supply channels. Duplication of personnel was unavoidable because 
of the necessity of assigning flight surgeons who were experienced in the care 
of flying personnel; there was duplication of supplies; and there was duplica- 
tion of administrative procedures in connection with patients evacuated by air. 245 
In terms of these considerations, G-3 therefore refused to reconsider its 
action on the five station hospitals, stating that "The functions performed by 



112 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



[them] • . . will now be performed at a substantial saving in manpower by 
medical personnel provided within the Manning Table for the North Atlantic 
Wing, Air Transport Command, and absorbed within the Air Transport Com- 
mand bulk allotment." 246 

It would appear that this case was closed with G-3 refusing to reconsider 
its earlier action, but actually a^very real question had to be answered insofar 
as operation of these medical installations was concerned. Were these installa- 
tions station hospitals? If so, they must be so designated, argued the Air 
Surgeon, in order "to draw needed medical supplies, equipment, and patients' 
rations, and to operate a hospital mess and a hospital fund, and to submit proper 
hospital reports for the necessary continued operations of the hospital. . . 247 
The Air Surgeon further stated : 248 

War Department policy provides that overseas hospitals be furnished by the Army Service 
Forces and operated by the SOS of the theater — except when otherwise authorized by 
the War Department. The War Department has authorized the Commanding General, 
AAF, to furnish medical services at the stations referred to. The medical services necessary 
for the proper care of the military personnel are obviously station hospitals — which the 
installations referred to have been, and remain. 

If the Commanding General could operate hospitals outside the continental 
United States when directed to do so by the War Department, the Air Surgeon 
was of the opinion that he could designate these installations station hospitals, 
and recommended that this be done. 249 

The Air Judge Advocate could see no legal question involved except possibly 
in the wording of the proposed hospital designations; however, it was believed 
that the station hospitals should be "numbered" rather than referred to by 
location. 250 The Office of Commitments and Requirements, AAF, accordingly 
advised the Air Surgeon that action had been taken to have the War Depart- 
ment authorize the redesignation of the five medical installations as AAF station 
hospitals, such designation being necessary to their operation. 251 But should 
such designation be disapproved, it was recommended as an alternative that 
these installations "be authorized to draw patients' rations, needed medical sup- 
plies and equipment and be further authorized to operate a hospital mess and a 
hospital fund. 252 When The Surgeon General 253 reaffirmed his position that to 
designate these installations as station hospitals would violate current War 
Department policy which charged the Commanding General, Army Service 
Forces, with the responsibility of activating and staffing all overseas fixed hospi- 
tals, the alternative proposal of the Air Forces was approved. 254 The installations 
were considered dispensaries with "prerogatives of station hospitals for pur- 
poses of administration and supply. . . . 255 As a result of this action, a letter 



THE WAR MISSION 



113 



was published by The Adjutant General's Office authorizing specific functions 
for the five dispensaries which would enable them to act as station hospitals. 2 " 6 

Later, similar action was taken in the case of the South Atlantic Wing, 
Air Transport Command, which initiated a movement on 9 May 1945 to have 
the 193d and 194th Station Hospitals located at Belem, Brazil, and Natal, 
Brazil, inactivated and replaced with AAF dispensaries. This request was 
supported by the claim that an economy of medical personnel would be effected 
and that Army Air Forces personnel were predominant at the base. At Natal 
the Army Air Forces personnel numbered 1,278 while the personnel of the 
Army Service Forces and Army Ground Forces numbered 414. At Belem 
there was a ratio of 496 to 265 and it was anticipated that this predominance 
would be increased. 257 

The Commanding General, Air Transport Command, concurred in the 
request, stating that the bases where the hospitals were located were Air Trans- 
port Command controlled bases; that a saving of 18 percent in medical person- 
nel could be effected; and that under the present situation the Commanding 
General, Air Transport Command, although charged with the responsibility 
for the health of his command, had no jurisdiction over the Army Service 
Forces surgeons at these bases. 258 It was therefore recommended that these 
dispensaries be given War Department authority to carry out specific functions 
which would make them station hospitals in fact if not in name. 

The Air Surgeon concurred in the request of the Air Transport Command 
to inactivate the two hospitals and replace them with AAF dispensaries, and 
forwarded the correspondence to OPD for decision. 259 In turn, OPD sent the 
correspondence to The Surgeon General "for remark and recommendation 
to include a statement as to the delineation of medical responsibilities between 
the theater commander and the ATC Division commanders concerned." 260 

In this instance, the Office of The Surgeon General disapproved, noting 
that the plan contemplated the transfer of responsibility for fixed hospitaliza- 
tion in the area from the Army Service Forces to the Army Air Forces, and 
that while the installations would be technically designated as dispensaries, 
they would in fact be station hospitals. Hence, this action would violate the 
principle of having one War Department agency responsible for overseas fixed 
hospitalization, and would lead to duplication of facilities and confusion over 
lines of responsibility. It was stated, however, that a flight surgeon could 
command a fixed hospital if this were desirable without the transfer of the 
unit to the Air Force commander. 261 OPD concurred with the views expressed 
by the Office of the Surgeon General. 262 



114 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Mission Accomplished: 1945 

In early 1945 The Surgeon General was to make one final attempt to regain 
his prewar status at the War Department General Staff level and to carry out 
his duties as Surgeon General of the Army. (He did not use the term Surgeon 
General of the Army Service Forces.) In a memorandum to the Secretary of 
War in January 1945 he summarized his view concerning "the sufficiency of 
facilities and personnel to cope with the prospective demands for medical service 
resulting from the prolongation of the war in Europe and the coincident fighting 
in the Pacific. 263 Only that part of his study which refers to organizational 
difficulties is of interest at this point. The Surgeon General expressed himself 
as follows: 264 

One of the principal administrative difficulties which I have encountered can be sum- 
marized under the one statement that, outside of the Army Service Forces, I have responsi- 
bilities as The Surgeon General of the Army which I am unable to discharge effectively 
because of the structure of separate commands (Army Ground Forces, Army Air Forces) 
and Theaters. It has long been recognized that with Zone of Interior hospitals under 
separate commands, unified staff planning is essential if duplication and other wastes are to 
be avoided. With medical means widely dispersed among the theaters, maximum 
utilization thereof can only be assured if staff supervision is constantly exercised by my 
office. There are multiple examples of under-utilization of medical means resulting from 
theater autonomy which could be remedied by such staff supervision. When dealing with 
problems outside the Army Service Forces, it is my recommendation that my position as 
staff advisor to the War Department be recognized, to enable me to take the staff action 
inherent in my responsibilities as The Surgeon General of the Army. 

The memorandum of The Surgeon General was sent to the Commanding 
General of the Army Air Forces for comment. 265 Prepared by the Air Sur- 
geon, that comment stated that the Commanding General of the Army Air 
Forces was thoroughly satisfied with the organizational operation of the med- 
ical services of the Army Air Forces in the Zone of Interior, and that any changes 
which would result in a loss of operative control of these services would seri- 
ously jeopardize the health of his command. 266 

A series of conferences, initiated by G-i and attended by representatives of 
all interested agencies, was held to consider the problems of The Surgeon 
General. At the conference held on 16 January 1945, it was agreed that The 
Surgeon General prepare a War Department Circular to "define his position 
as Surgeon General of the Army, clarify and assure recognition as staff adviser 
to the War Department, and assure maximum possible control of the medical 
means available, through staff supervision, without interfering with the current 
structure of the Army." 267 Brig. Gen. R. W. Bliss of the Office of The Surgeon 



THE WAR MISSION 



115 



General prepared a proposed circular and forwarded a copy to the Office of the 
Air Surgeon on 7 February 1945. 268 

A study of this proposed circular showed that it would have increased the 
authority of The Surgeon General to the point of conflict with command 
functions under the current organization of the Army. Lt. Col. R. B. Ruther- 
ford, Special Assistant to the Air Surgeon, in analyzing the circular for the 
Air Surgeon, referred to the resultant increase in power in these terms: "Be- 
cause of the broad over-all terminology utilized, the circular gives The Surgeon 
General powers far beyond those currently authorized by either Army Regula- 
tions or staff directives and envisions a medical command under the control 
of The Surgeon General." 269 In this connection, two paragraphs deserve 
special emphasis. Paragraph 2b gave The Surgeon General the right "To 
exercise staff supervision over the activities of the Medical Department in all 
components of the Army, and the utilization of all medical means and person- 
nel." This provision was worded in such a manner that staff supervision over 
the "utilization of all medical means and personnel" could mean operational 
control, and if interpreted in this manner would violate the command function 
of the Commanding General of the Army Air Forces, for the operational 
control of the medical service of the Army Air Forces was vested in the 
Commanding General, Army Air Forces. 270 Paragraph 3a, however, caused 
the greatest concern to the Air Surgeon's Office. This paragraph stated that 
"All plans, policies, and procedures having medical aspects, will be cleared 
with The Surgeon General." This provision, it was believed, would have 
arrested and disrupted the medical services of the Air Forces, for it would have 
been necessary to clear every act of the Air Surgeon's Office with The 
Surgeon General. 

The proposed circular was returned to the Commanding General, Army 
Service Forces, 271 for reconsideration, as a result of which it was redrafted to 
conform more closely with current War Department policies. 272 Several changes 
were made which materially reduced the powers of The Surgeon General from 
those provided for in the original draft of the circular. In the original draft, 
The Surgeon General was declared the "Chief Medical Officer of the War De- 
partment, the Chief Medical Adviser to the Secretary of War, the Chief of 
Staff, the War Department and all components of the military establishment!' 273 
In the redrafted version the reference to "all components of the military estab- 
lishment" was omitted. Another limitation was contained in paragraph 2 of 
of the new draft. "The Surgeon General is assigned responsibility for estab- 
lishing army-wide™ plans and policies. All such plans and policies [i. e., 



116 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

army-wide] initiated by other agencies will be cleared with The Surgeon 
General." Thus the scope of this provision was far less inclusive than the 
over-all statement in the original draft that "All plans, policies, and procedures 
having medical aspects, will be cleared with The Surgeon General." Para- 
graph 2a gave The Surgeon General the authority to "prepare for publication 
as War Department directives general policies and technical procedures, stand- 
ards and methods which have an Army-wide application . . after securing 
recommendations from the major components of the Army where appropri- 
ate!' 21 ' 0 Hence, this paragraph provided limitations on the right to publish 
War Department directives. It is interesting to note that although the original 
draft of the circular made no mention of the position of The Surgeon General 
in the Army Services Forces, although certainly a part of his administrative 
difficulties stemmed from this position, the revised draft of the proposed cir- 
cular, made it plain that The Surgeon General would remain under the Army 
Service Forces as provided in the March 1942 reorganization. 

The comment of the Office of the Air Surgeon to the revised circular is 
quoted at some length: 276 

2. . . . The medical problems and administration of the medical services peculiar 
to the three major commands and to the various theaters must be solved by the respective 
military commanders, who alone are familiar with both the medical and the military influ- 
encing factors. Operations — the fruition of War Department policy — is a responsibility of 
command whether the operation be tactical, technical, or administrative in nature. 

3. Unless the position of The Surgeon General is adequately defined so as to separate 
clearly his primary duty as medical adviser to the War Department from his additional 
duty as surgeon of the Army Service Forces, there will be confusion as to his advisory 
responsibility to the War Department and his operational responsibilities for the provision 
of the medical service for the Army Service Forces. 

4. The need for a staff agency charged with the responsibility of establishing basic 
plans and policies pertaining to the technical professional medical care of the Army is recog- 
nized. However, the effectiveness of this agency is compromised when, in addition to its 
prescribed functions, it assumes operational control and operational supervision within the 
three major Commands and the various Theaters. Decentralization is as important to the 
provision of adequate medical service as it is to other aspects of command. Furthermore, 
decentralization precludes the establishment of a large overhead agency which, because of 
its size and remoteness, is not in a position to be cognizant of the problems peculiar to the 
several commands and theaters. 

5. War Department Circular 59, 1942, delegates to the Commanding Generals of the 
three major commands the operational control of their respective commands. The assump- 
tion of any aspect of operational control of the personnel or facilities of the Army Air Forces 
by a head of a technical service of the Army Service Forces is a violation of the basic concepts 
of established War Department policy (which has withstood the test of three years of war 
service), and of the prerogatives of the Commanding General, Army Air Forces. 



THE WAR MISSION 



117 



In Comment No. 4 to G-1, 277 the Air Surgeon made specific references to 
paragraphs in the proposed circular which were considered to be operational 
in nature. For example, paragraph ia gave The Surgeon General the right 
to "Make recommendations to the Chief of Staff and the War Department 
General and Special Staffs on matters pertaining to the health of the Army 
such as utilization of medical facilities, equipment and personnel" The Air 
Surgeon objected to this provision saying that "Most aspects of the utilizaton 
of medical facilities, equipment, and personnel are purely operational in nature." 
Therefore, this paragraph was in contradiction to paragraph 5, which assured 
the commanding generals of the three major commands the responsibility for 
the internal organization and operation of the medical services of their com- 
mands. It was suggested that the latter part of paragraph ia be deleted — "such 
as utilization of medical facilities, equipment, and personnel." Objection was 
made also to paragraph ic, which was stated in these terms: "Exercise advisory 
supervision over the medical department activities in all components of the 
Army, . . ." Paragraph id concerning "technical inspections at installations 
throughout the Army . . likewise was objected to for the same reason — 
that technical inspection could be interpreted to include operational control. 
The Chief Surgeon of the Army Ground Forces registered virtually the same 
objections to the proposed circular as did the Office of the Air Surgeon, Army 
Air Forces. 278 

In order to facilitate the consideration of the circular, it was recommended 
by the Office of the Air Surgeon that a committee consisting of representatives 
of the Assistant Chiefs of Staff, G-i, G-3, G-4, OPD, The Surgeon General, the 
Army Ground Forces, and The Air Surgeon be appointed for this purpose. 279 
At a final conference called by G-i on 12 March 1945, certain changes were 
made in the circular, generally coinciding with those suggested by the Army 
Air Forces and the Army Ground Forces. 280 All agencies represented con- 
curred in the changes except The Surgeon General and the Army Service 
Forces. The Surgeon General held that the circular did not reaffirm the 
position of The Surgeon General in a satisfactory manner, since he was limited 
to Army-wide activities only. Specific objections were made to paragraphs ic 
and d, which were written as follows: 

ic. Exercise technical staff supervision in conformity with War Department directives 
over all medical activities applicable to the entire Army. 

d. Make technical inspections pertaining to the health of the Army. These inspections 
will be made in such manner as not to interfere unduly with the training or other activities 
of the troops or installations visited, and will be fully coordinated with the major command 
concerned. 



118 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



The Army Service Forces objected to direct channels of communication 
between The Surgeon General and the War Department General and Special 
Staff, and the major commands, as provided by paragraph 3, which indicated 
that the Commanding General of the Army Service Forces proved to be just as 
reluctant to give The Surgeon General greater authority as were the command- 
ing generals of the other major commands. As a result of this objection, 
paragraph 3 was changed to permit direct channels only on matters of a routine 
nature. When the final draft of the circular was presented to the Secretary 
of War for approval for publication, however, he supported The Surgeon 
General with these words: 281 

I consider that the care of the sick and wounded and the character of the hospitaliza- 
tion in the Army are matters for the direct responsibility of the Secretary of War; also that 
The Surgeon General should be his principal adviser in regard to these vital matters. To 
that end I wish it clearly understood that I am to have direct access to him and he to me on 
such matters whenever either of us deems it to be essential. 

An analysis of Circular No. 120 as finally published 282 shows how little 
the status quo of the Medical Department was changed. The Surgeon General 
asked originally that he be permitted "To exercise staff supervision over the 
activities of the Medical Department in all components of the Army, and the 
utilization of all medical means and personnel." He requested further, that 
"All plans, policies, and procedures having medical aspects, ... be cleared 
with The Surgeon General," with direct channels of communication between 
him and the Chief of Staff, the War Department General and Special Staffs, 
and the major components of the Army on all matters pertaining to staff 
responsibilities. According to the published circular, The Surgeon General 
was declared to be the chief medical officer of the Army and the chief medical 
adviser to the Chief of Staff and the War Department, and could "make recom- 
mendations to the Chief of Staff and the War Department General and Special 
Staffs on matters pertaining to the health of the Army including recommenda- 
tions relative to the utilization of medical facilities, equipment and personnel." 
He could prepare for publication War Department directives containing general 
policies and technical procedures if they pertained to medical matters of Army- 
wide application and were approved by the War Department. Yet before any 
directive affecting the medical services of the Air Forces could be published, 
it would be necessary for it to be Army-wide in nature and approved by the 
War Department, a limitation which made the provision of this paragraph 
largely meaningless. The Surgeon General exercised technical staff super- 
vision over medical means available, but only in conformity with War Depart- 
ment directives, which in effect, meant the status quo would be maintained. 



THE WAR MISSION 



119 



He could make inspections but such inspections must be "coordinated with the 
commanding generals of the major forces, commands, departments, or 
theaters concerned," which meant that permission must be granted by the 
commanding general involved before an inspection could be made. While all 
plans and policies of Army-wide medical aspects must be coordinated with 
The Surgeon General, this provision was materially restricted by the adjective 
Army-wide. Direct communication was authorized between The Surgeon 
General, the War Department, and major commands only on medical matters 
of a routine nature. All other matters involving the establishment of policies 
or procedures must be sent through channels of the Army Service Forces. At 
the insistence of the Commanding General, Army Service Forces, the provisions 
of War Department Circular No. 59, 1942, placing The Surgeon General under 
the command of the Commanding General, Army Service Forces, remained 
in effect. Finally, paragraph 5 assured the commanding generals of the major 
forces, commands, departments or theaters of the responsibility for the 
internal organization and operation of their medical services. 

This published circular and the discussions centering around it have been 
treated at length because they reveal with clarity the situation that existed as 
V-E Day and V-J Day drew near. Circumscribed as he was by his relatively 
low echelon in the War Department organization, The Surgeon General could 
not fulfill his mission as he envisoned it; only by occupying a position on the 
War Department General Staff could he do so, and this was denied him. 
When he tried to centralize military medical services under his operational 
control, he was unsuccessful because he came in conflict with the com- 
mand jurisdiction of the three major commands. While the Air Surgeon 
favored raising The Surgeon General to War Department General Staff status 
in an advisory and coordinating capacity, he could not endorse the move 
toward centralizing all medical activities under Army control. The wartime 
experience had demonstrated that this was not feasible, since the Army Air 
Forces had moved too rapidly toward autonomy to depend upon another 
military service for its medical support. 

As V-E Day approached, the shortage of medical aid for the civilian pop- 
ulation became increasingly critical. 283 Looking toward the close of hostilities, 
however, The Surgeon General on 13 April 1945 discussed a plan for the release 
of Medical Corps officers so that the current War Department ceiling of 45,000 
would be met by approximately December 1945. 284 This plan anticipated the 
release of approximately 2,900 Medical Corps officers by December 1945 since 
newly commissioned officers would have been brought on duty during the 
period. 



120 MEDICAL SUPPORT OF THE ARMY AIR FORCES IS WORLD WAR II 



Two weeks later the War Department published Readjustment Regulation 
1-5, outlining personnel procedures to be followed in the readjustment of offi- 
cers after the defeat of Germany. Officers as defined in this publication 
included all except Regular Army, permanent members of the Army Nurse 
Corps, and general officers. Only Medical Department officers are of concern 
in this chapter. The fundamental principle and controlling factor to be fol- 
lowed in the selection of surplus and nonessential officers was military neces- 
sity; however, the adjusted service rating score was to be given consideration, 
"especially in the case of officers with lengthy service overseas and long and 
hazardous service in combat!' 285 

The Commanding Generals of the Army Ground, Air, and Service Forces 
were charged with the responsibility of declaring the essentiality of officers, 286 
with the Commanding General, Army Service Forces, having jurisdiction over 
Medical Department officers. 287 Before an officer could be declared nonessen- 
tial, it must be determined that he was not required by the Army as a whole 
and not merely by a major force, 288 a principle which made it impossible for 
the Army Air Forces to separate its surplus Medical Department officers with- 
out first determining whether they were needed by the Army Service Forces. 
If so, they were subject to transfer. 

Provisions were made for determining adjusted service rating scores and 
efficiency indices. The adjusted service rating would be based on service credit 
and overseas credit, figured in each case from the number of months served 
since 16 September 1940; combat credit, based on the number of decorations 
and bronze service stars awarded for service since 16 September; and parent- 
hood credit, which would be allowed for children under 18 years. 289 The 
War Department would determine the amount of credit for each factor as 
well as the effective date. 290 It was required that an efficiency index be com- 
puted for each officer. Numerical values in the rating scheme ranged from 
50 to — 10, to be interpreted in this manner: 291 

Superior 50 Satisfactory 20 

Excellent 40 Unsatisfactory 10 

Very Satisfactory 30 

One of the initial steps taken by The Surgeon General concerning the 
separation of surplus Medical Department officers was the appointment 11 May 
1945 of a Separations Board composed of Maj. Gen. George F. Lull, USA, 
Deputy Surgeon General; Lt. Col. Gerald H. Teasley (MC), Personnel Service; 
Maj. Edwin S. Chapman (MC), Office of the Ground Surgeon; and Maj. 
William A. Glasier (MC), Office of the Air Surgeon. 292 This Board was 



THE WAR MISSION 



121 



authorized to evolve separation policies and to supervise the separation of 
Medical Department officers under policies established. 293 The office order 
establishing the board was amended 5 days later to give the board final reviewing 
authority on all cases for separation under the provisions of War Department 
Circular No. 485 and Readjustment Regulations 1-5. 294 

Under War Department readjustment regulations, as noted earlier, the 
Commanding General of the Army Service Forces was given the responsibility 
of determining the essentiality of all Medical Department officers, thereby 
giving him the authority to reassign to units under his jurisdiction those Medical 
Department officers whom the Air Forces wished to return to civil life. The 
Air Surgeon objected to the exercise of such authority by the Commanding 
General of the Army Service Forces and stated his reasons in a memorandum 
to General Arnold on 28 May 1945, First, he said, there was no bona fide 
shortage of Medical Corps officers in any component of the Army. To substan- 
tiate this statement it was pointed out that at this time there were 18,000 Medical 
Corps officers on duty in the European and Mediterranean Theaters; that Zone 
of Interior hospitals were staffed at 98 percent of authorized manning guides 
with only 68 percent occupancy; that 1,600 newly graduated Medical Corps 
officers were being placed on active duty; and that the troop strength of the 
Army had been reduced and undoubtedly would be further reduced. It was 
stated further that the Air Forces procured all but a small number of these 
officers on the basis of individual requests for duty with this branch of the 
service. Hence, the Air Forces should be responsible for returning them to 
civil life when their services were no longer needed. Reference was also made 
to the critical civilian need for these doctors. 

In order to accomplish separation, it was recommended that: 295 

a. The Army Air Forces be given the authority to return directly to civilian life, through 
appropriate separation centers, all Medical Corps officers whose service it no longer requires. 

b. This action to be accomplished by the separation of officers on the following basis: 

( 1) Officers declared surplus through reduction of Army Air Forces troop basis. 

(2) Officers declared surplus due to replacement by newly appointed officer personnel 
under Procurement Programs. 

The Air Surgeon's recommendations were carried by Lt. Gen. Ira C. Eaker to 
the Deputy Chief of Staff, WDGS, who disapproved them. 296 

The policies for the separation of Medical Department officers evolved 
slowly between V-E and V-J Day, and criteria established for separation could 
be met by only a very few officers. During this period only 144 Medical Corps 
and 14 Dental Corps officers who were on duty with the Army Air Forces were 
separated. 297 



122 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



It was during this period, however, that necessary planning was accom- 
plished. At this time policy called for establishing critical Military Occupational 
Specialties (MOS), and all officers coming within these classifications would 
be ineligible for relief until such time as the MOS was no longer critical. Other 
MOS's not required by any of the three major forces were to be declared non- 
essential and discharged by each major force. Although each application for 
separation must be reviewed by The Surgeon General's Separation Board, such 
review, it was asserted, would be "perfunctory." It is clear that this plan would 
be unsatisfactory to those officers in the critical categories who wanted to be 
relieved from active duty. 

On 14 June 1945 the Air Surgeon's Office announced that all Medical 
Department officers 50 years old and older and not classified as neuropsychi- 
atrists or orthopedic surgeons were considered nonessential to military needs 
with the provision of RR 1-5, and hence subject to release from active duty. 298 
This policy of excepting the neuropsychiatrists and orthopedic surgeons from 
release under the age criterion was changed on 26 August 1945 to make it 
apply to all Medical Department officers. 299 

Agreements were reached with Assistant Chief of Air Staff — Personnel, 
Separations Branch, which authorized the Air Surgeon's Office to handle all 
separation cases of Medical Department officers under the provisions of RR 
1-5, 800 and with G-i which authorized the Commanding General, Army Air 
Forces, to relieve surplus Medical Corps officers under the provisions of RR 1-5 
at Army Air Force stations authorized to make final type physical examina- 
tions, provided officers to be released were currently assigned to a Zone of 
Interior installation. 801 Both of these agreements helped to expedite the sepa- 
ration process. 

As of 1 June 1945, there were 4,619 Medical Corps officers on duty with the 
Army Air Forces in the Zone of Interior serving 1,135,001 troops, or a ratio of 
4.06 Medical Corps officers per 1,000 troops. 302 At the same time, a similar 
comparison showed there were 14,515 Medical Corps officers on duty with the 
Army Service Forces and the Army Ground Forces serving a troop strength 
of 1,749,556, or a ratio of 8.3 Medical Corps officers per 1,000 troops. 

In an informal conference with G-i on 25 July, the Air Surgeon repre- 
sentative stated that the Army Air Forces contemplated releasing within the 
Zone of Interior, Medical Corps officers listed in the categories below: 

Medical Schools 55 

RR 1-5 (100 points or over) 100 

Over 50 years of age 10 

Total 165 



THE WAR MISSION 



123 



It was agreed to relieve Medical Corps officers in overseas theaters as follows: 



By proper assignment and distribution it was estimated that there could be a 
further reduction of Medical Corps officers to 3.5 per 1,000 troop strength, 
resulting in a surplus of 567 more Medical Corps officers; however, it was argued 
that before a further reduction should be ordered for the Air Forces, a more 
equitable distribution of Medical Corps officers among the major forces should 
be accomplished. 303 

On 26 July 1945 ^ e Ah" Surgeon's Office advised commands 304 and other 
installations of the necessary adjusted service rating 305 score for the separation 
of Medical Corps officers. This ASR score was set at 100 for all classifications 
which were considered critical except those listed below: 306 

3 1 05 Gastro-enterologist. 

3106 Ophthalmologist and Otolaryngologist. 

3107 Cardiologist. 

3 1 1 2 Dermatologist. 

31 13 Allergist. 
31 15 Anesthetist. 

3150 Neuropsychiatrist. 
3 1 3 1 Neurosurgeon. 

3 151 Thoracic Surgeon. 

3152 Plastic Surgeon. 
3163 Orthopedic Surgeon. 

3303 Medical Laboratory Officer. 

To be eligible for release, officers listed in the critical categories must have an 
ASR score of 120. 

This announcement by the Air Surgeon's Office of the requirements for 
release of Medical Corps officers was based upon criteria established by The 
Surgeon General for the separation of all Medical Department officers and 
published by the Army Service Forces on 19 August 1945. 307 In addition to the 
requirements for release of an ASR score of 100, or 120 for officers in the list 
of scarce categories as applied to all Medical Corps officers returned from 
a theater or declared surplus by a major force, other separation criteria were 
established by the Army Service Forces. Any Medical Corps officer 50 years 
of age or older was eligible for relief except those on duty in the general hospitals. 
Not only did the age criterion fail to apply here, but officers in nonsurplus 
categories must have an ASR score of 1 10 or above to be eligible. 

262297°— 55 10 



RR 1-5 surplus in ETO 

RR 105 to be replaced by MC in ZI 



5° 
213 



Total 



263 



124 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Criteria for the release of other Medical Department officers follow: 

Dental Corps: 

1. ASR score 100 or above. 

2. Age 50 or above. 

3. However, it was desired that Dental Corps officers in the Zone of Interior not be 

declared surplus at the present time under the age provision nor on an ASR score 
under no. 

Medical Administrative Corps: 

1. ASR score 90 or above. 

2. Age 45 or above. 

Sanitary Corps: 

1. ASR score 90 or above. 

2. Age 45 or above. 

Army Nurse Corps: 

1. ASR score of 65 or above. 

2. Age 40 or above. 

3. Service one year or more. 

4. Dependent children under 14 years of age. 

5. A nurse of field grade with an MOS-3430 must have an ASR score of 90 or more. 
Physical Therapists and Dietitians: 

1. ASR score of 65 or above. 

2. Age 50 or above. 

3. Service one year or more. 

4. Dependent children under 14 years of age. 

5. Married to individuals who have been separated from the service. 

To facilitate the separation of Medical Department officers under these and other 
published criteria, 308 authority was delegated to each major command and air 
force, which authority could be further delegated as desired, to separate eligible 
Medical Department officers without reference to Headquarters, Army Air 
Forces. 309 

It was necessary to establish criteria for movement of Medical Department 
officers overseas since obviously it would be unfair, as well as uneconomical, to 
send high score officers overseas who would shortly be eligible for separation. 
Taking cognizance of this situation, The Surgeon General recommended the 
establishment of these criteria restricting the movement of officers overseas; 31<) 

a. Officers with previous overseas service of six months or longer. 

b. Officers forty years of age or older. 



THE WAR MISSION 



125 



c. Officers with the following adjusted service rating or higher: 

MC 65 ANC 30 

DC 50 VC 50 

MAC 50 PT 30 

SnC 50 MD Dietitians 30 

d. Officers eligible for separation by virtue of length of service. 

The policy for the remainder of 1945 reflected a series of steps progressively 
lowering the criteria for separation. The Surgeon General's Separation Board 
recommended on 10 September 1945, after careful study of available statistical 
information, that ASR score and age criteria be lowered considerably. This 
recommendation, approved by G-i, set up the following new criteria for sepa- 
ration of Medical Department officers: 311 



Corps 


ASR 


Age 


Length of service 


MC 


80 


48 


Pearl Harbor.* 


DC 


80 


48 


Pearl Harbor. 


VC 


80 


42 


Prior to 1941. 


SNC 


70 


42 


Pearl Harbor. 


MAC 


70 


42 




ANC** 


35 


35 




MDD** 


40 


40 




PT** 


40 


40 





♦A, B, and C of the following: Ophthalmologist and Otorhinolaryngologist (3106), Orthopedic Surgeon 
(3153), and Medical Laboratory Officer (3303); all grades of Ncuropsychiatrist (3130) and Plastic Surgeon 
(3152). [Officers in these categories were eligible for relief if they were called to active duty prior to 1 Jan 
1941. See ASF Letter to CGs, Service Commands, etc., 15 Sept 1945, AG 210.31 (10 Aug 1945) (17).] 

♦♦Married, dependents under 14. 



It should be noted from this table that the ASR score and age criteria 
for separation were materially lowered. Furthermore, the extraordinary re- 
quirements for those officers in the scarce categories were removed with the 
exception of the length of service. To meet this criterion for separation these 
officers must have been called to active duty prior to 1 January 1941, instead 
of prior to 7 December 1941 as was true with all other officers. Also, the list 
of scarce categories was considerably decreased. A time limit was placed on 
the right to keep an officer on duty awaiting replacement, under the principle 
of military necessity. This limit was set at 15 December 1945 or the time of 
arrival of the replacement. 312 



126 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



There were some fundamental difficulties between the Air Surgeon and 
The Surgeon General over the release of Medical Department officers. The 
chief AAF commitments were in Zone of Interior installations, which re- 
sponded quickly to demobilization procedures. It was thus possible to release 
Medical Department officers on duty with the Air Forces in excess of the 
number who would be eligible for separation under established War Depart- 
ment criteria. Yet, as previously noted, every medical officer declared surplus 
by the Air Forces was subject to reassignment by The Surgeon General to 
Army Service Forces units. That this policy slowed the declaration of Medical 
Department officers on duty with the Air Forces as surplus was frankly 
admitted by the Air Surgeon's Office. 313 

The fact that the number of doctors being released from the Army was 
negligible 314 brought on a storm of Congressional and public criticism of the 
War Department. Maj. Gen. G. V. Henry, Assistant Chief of Staff, G-i, 
taking cognizance of the unsatisfactory progress being made in the release of 
Medical Department officers, addressed strong letters on the subject to The 
Surgeon General and the Air Surgeon, 315 with an inclosed copy of a personal 
message from Maj. Gen. T. T. Handy, Deputy Chief of Staff, to General 
Dwight D, Eisenhower on the same subject. Parts of the latter message are 
quoted below to show the gravity of the problem: 316 

The War Department has been under heavy fire especially from members o£ Congress 
for some time to return medical personnel to civilian life. . . . Cases are cited in which 
whole groups of towns in some of the rural areas are completely devoid of medical service. 
The situation is definitely critical with winter coming on. For some months efforts have 
been made to obtain the early return of doctors who are no longer needed in the Army 
so they could be released. The numbers returned to date have been insignificant. It is 
imperative that every doctor, nurse, and dentist, regardless of their point scores, who can 
be spared, be screened out of units or installations and returned to the United States by 
fastest available means of transportation. . . , 

General Grant's reply to General Henry's letter contained a frank discussion 
of the problem, showing how former efforts to obtain authority to release medi- 
cal officers had been rebuffed by G-i. This letter is quoted at length to show 
the position of the Air Surgeon: 317 

You will remember that as far back as last April I approached G-i on the subject 
of discharge of medical officers, but was unable to get any authority whatsoever, being told 
that if there were surplus medical officers they would have to be transferred to the Service 
Forces. This, as you know, I protested because I considered that the Service Forces were 
also in excess of medical officers at that time. 

This office has been continually on record as desiring to discharge all surplus medical 
officers. Two months ago, when the list of essential doctors was submitted by the medical 



THE WAR MISSION 



127 



schools, those that were in the AAF were discharged ido percent, as opposed to the Service 
Forces discharging about 40 percent. 

Under the new criteria as published just recently, I have issued orders that there will 
be no exception and no essentiality declared in the case of any individual. I am very much 
disappointed that the War Department has not allowed the major commands to discharge 
surplus medical officers as declared by them, regardless of their eligibility under any point 
score. 

The point score and other criteria for release of Medical Department 
officers continued to be too high for the release of all surplus officers on duty 
with the Air Forces. Thus, every surplus officer not able to meet current 
separation criteria was subject to reassignment by The Surgeon General. 
While The Surgeon General had delegated to the Air Surgeon the authority 
to determine the essentiality of Medical Department officers of the Air Forces 
who met current separation criteria, 318 this step failed to alleviate the problem 
since it did not give the Air Surgeon the right to determine the essentiality 
of surplus officers who could not meet such criteria. The Air Surgeon's Office 
forced the issue in a letter to the Chief, Personnel Division, Office of The 
Surgeon General, dated 16 November 1945. This letter stated that, owing 
to recent and contemplated rapid reduction in troop strength in the Army 
Air Forces which resulted in closing and combining of installations, the need 
for Medical Department officers was rapidly decreasing also. It was suggested 
therefore that the ASR score be reduced to 60 points as of 20 November 1945. 
In arguing against the transfer of these officers to units outside the Air Forces, 
it was stated that virtually all of the Medical Corps officers on duty with the 
Air Forces had been recruited by the Air Surgeon's Office after each doctor 
specifically stated his desire for such service ; that after completion of their work 
with the Air Forces these doctors should be released to civil life; and that to 
transfer them would be unfair and would, without doubt, result in a reduction 
in the efficiency of their work. Should The Surgeon General's Office be unable 
to reduce criteria for separation to an ASR score of 60 points as suggested, 
it was "urgently recommended" that "the Army Air Forces, acting for the 
Surgeon General's Separation Board, and without referral to the Office of the 
Surgeon General, separate those medical officers who were currently surplus." 319 

General Bliss, Chief, Personnel Division, Office of the Surgeon General, 
disapproved all recommendations of the Air Surgeon's letter. He advised that 
a study was in progress to determine the advisability of reducing the ASR score 
for the separation of Medical Department officers but that at present no 
information was available to indicate what action was forthcoming. Concern- 
ing the transfer of Army Air Forces medical officers to the Army Service Forces, 



128 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



it was stated that the representatives of The Surgeon General's Personnel 
Service found many Medical Department officers serving with the Air Forces 
overseas who were interested in professional refresher assignments in Zone of 
Interior general hospitals. And in refusing to delegate authority to the Air 
Surgeon to release surplus officers without referral to the Office of the Surgeon 
General, it was stated that criteria for the separation of Medical Department 
officers must be on an Army-wide basis, and, as a consequence of transferring 
Air Forces medical officers to the Army Service Forces, separation criteria could 
be lowered for Medical Department officers of the whole Army. 320 

Eventually The Surgeon General, taking cognizance of surplus Medical, 
Dental, and Army Nurse Corps officers in the Zone of Interior who were not 
eligible for separation under current criteria, devised a method of separating 
such officers, based on 2 years' active duty for the Medical and Dental Corps 
and one year for the Army Nurse Corps, irrespective of ASR score or age. 
It was stipulated that each case must be referred to The Surgeon General for 
approval, with telephonic and telegraphic communication authorized in order 
to expedite the procedure. 321 

It was a matter of interest to the Air Surgeon when a conflict developed 
between the Secretary of War's Separations Board and The Surgeon General's 
Separation Board over cases coming under the provision of Section III, War 
Department Circular No. 290. Before the plan for the separation of Medical 
Department officers provided for in Readjustment Regulations 1-5 became 
effective, War Department Circular No. 485, 29 December 1944, provided two 
methods of release from active duty. Section III provided for release essential 
to national health, safety, or interest, while Section IV provided for release for 
undue hardship cases. In either case applications for release were sent through 
command channels to Officers Branch, Separations Section, Office of the Adju- 
tant General, for forwarding to the Secretary of War's Separations Board, 
regardless of action taken on applications by forwarding commanders. 322 Ap- 
parently, to simplify the procedure for release under these sections, action was 
initiated to revise War Department Circular No. 485. However, it was an- 
nounced in an Adjutant General's letter of 29 August 1945, that, pending revi- 
sion, only applications for release under Sections III and IV which were 
disapproved by a major command would be sent to The Adjutant General for 
referral to the Secretary of War's Separations Board. 323 Section III, War Depart- 
ment Circular 290, 22 September 1945, provided for the relief of officers whose 
essentiality to the national health, safety, or interest could be definitely estab- 
lished from documentary evidence. The application, which must originate 
with the officer desiring relief, together with substantiating documents and other 



THE WAR MISSION 



129 



specific data required, was sent through command channels in cases of Zone 
of Interior personnel to the commanding general of the appropriate major 
command. Should the major command disapprove an application, it must "be 
forwarded to The Adjutant General, Attention: Officers Branch, Separations 
Section, for final consideration, accompanied by an indorsement stating reasons 
upon which action was based." In the case of Medical Department officers 
serving with the Air Forces, applications under this provision were reviewed 
by the Personnel Division, of the Office of the Air Surgeon with final decision 
being made by The Surgeon General's Separation Board. Disapproved appli- 
cations were forwarded to The Adjutant General's Office as directed. From 
here the applications were forwarded to the Secretary of War's Separations 
Board where final review and disposition were accomplished. 

The Air Surgeon's Office experienced administrative difficulty because the 
Secretary of War's Personnel Board, in reviewing applications disapproved by 
The Surgeon General's Separations Board, reversed some of the decisions of 
the latter board and did not notify the Air Surgeon's Office directly of action 
taken. The Personnel Division of the Air Surgeon's Office, handling the special 
order releases in a routine manner and not checking each release against dis- 
approved applications, had no immediate way of knowing the final disposal 
of these cases. In answering Congressional inquiries about the status of these 
applications, for example, the Personnel Division of the Air Surgeon's Office 
relied on the action taken by The Surgeon General's Separation Board without 
knowledge of the final disposition made by the Secretary of War's Separations 
Board. 324 That this system would lead to embarrassment is obvious, for the 
files of the Personnel Division of the Air Surgeon's Office would show that an 
individual's application was disapproved by The Surgeon General's Separations 
Board while at the same time the applicant may have been separated from the 
Army by action of the Secretary of War's Separations Board. 

Reacting to Congressional criticism from a case of this kind and to protest 
from one of the commands that such releases were detrimental to morale of 
Medical Department officers, the Personnel Division of the Air Surgeon's Office 
decided to go on record against the appellate jurisdiction of the Secretary of 
War's Separations Board over applications disapproved by The Surgeon General's 
Separations Board. 325 The recommendation was contained in a memorandum 
to G-i, 26 October 1945, from the Deputy Chief of Air Staff. 326 Three reasons 
in support of the recommendation were listed. First, action by Headquarters, 
Army Air Forces, had been governed in every instance by the decision of the 
Procurement and Assignment Services of the Federal Security Agency as to the 
essentiality of the applicant to his community. Apparently the intended infer- 



130 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



ence was that action in this manner by the Air Surgeon's Office would be 
preferable to that taken by a nontechnical board. The other two supporting 
arguments were based on criticism 327 of the War Department and the morale 
problem. 328 

Assistant Chief of Staff, WDGS G-i, transmitted the Air Forces memo- 
randum to the Secretary of War's Separations Board for comment or concur- 
rence. 329 The President of this Board, Maj. Gen. William Bryden, taking cog- 
nizance of the Air Forces statement that the recommendations of the two boards 
do not always agree, observed: 330 

It is the understanding of this Board that such cases are referred to it for decision on the 
merits as set forth in the record and from a broad consideration of all factors involved, and 
that this was particularly desired in the case of Medical Corps officers in view of the present 
wide-spread and insistent demand from civilian sources for the return of such officers to 
their civilian practices. 

Referring to the statement in the basic memorandum that action of Head- 
quarters, Army Air Forces, was governed by recommendation of the Procure- 
ment and Assignment Services, the President of the Board advised that "it would 
be helpful to this Board if evidence to that effect could be included in the record, 
since statements of local committees frequently are at variance with the action 
recommended by AAF, HQ." It was presumed from this statement that no such 
information was noted on the disapproved applications forwarded by Head- 
quarters, Army Air Forces. Finally, it was observed that only cases disapproved 
by The Surgeon General or a major command ever reached the board; hence 
to approve the basic memorandum would preclude the necessity of referring 
any cases to the Board under Section III, War Department Circular 290. It was 
therefore clear that the recommendation of the Air Forces, if approved, would 
prevent any appeal in these cases from the ruling of The Surgeon General's 
Separations Board. This position was untenable, considering the original rea- 
sons for charging the Secretary of War's Separations Board with final disposi- 
tion of disapproved applications, and was so held by the War Department. 331 
Not until 19 October 1945 was there any distinction made in separation 
criteria in favor of the Medical Department officers returned from overseas. 
Effective this date, applicable only to oversea returnee officers listed, criteria 
were announced as follows: 332 

(1) Medical and Dental Corps — 70 points or 45 months or more active service since 
16 September 1940. 

(2) Veterinary Corps — 70 points or entry on active duty prior to 7 December 1941. 

(3) Sanitary and Medical Administrative Corps — 60 points or 45 months or more 
active service since 16 September 1940. 



THE WAR MISSION 



131 



b. Officers who are willing to remain on active duty for three months or more following 
Temporary Duty for rest and recuperation and sign a statement as follows will be disposed 
of in the manner prescribed for returnees desiring to remain in the service: "regardless of 
any eligibility which I now have or may have in the future for relief from active duty under 
Readjustment Regulations, I elect unless sooner relieved to continue on extended active duty 
until (date to be supplied — not less than 3 months following termination of Temporary 
Duty for rest and recuperation) or for the duration of the emergency and six months if 
this occurs earlier." 

2. The foregoing criteria and statement for retention apply only to the Medical 
Department officers who are reporting to Reception Stations and have returned from overseas 
subsequent to 20 October 1945. Authority for separation will be Section II, War Depart- 
ment Circular 290, 1945. 

On 7 November 1945 it was considered advisable to revise downward the 
criteria for screening of Medical Department personnel for overseas movement. 
Therefore, officers meeting any of the following conditions would not be sent 
overseas: 333 

b. Medical Department officers: 

Medical Corps, ASR score 45, or age 40, or 2 years 6 months service. 

Dental Corps, ASR score 45, or age 40, or 2 years 6 months service. 

Sanitary Corps, ASR score 30, or age 35, or 2 years 6 months service. 

Medical Administrative Corps, ASR score 30, or age 35 or 2 years 6 months service. 

Nurses, ASR score 12, or age 30. 

Dietitians, ASR score 15, or age 30. 

Physical Therapists, ASR score 15, or age 30. 

On 17 December 1945 the requirements for separation of Medical Depart- 
ment officers relieved from overseas assignment and returned to the United 
States subsequent to 1 December 1945 were reduced as set forth in a TWX to 
the various Air Forces commands and installations. Such Medical Corps 
officers were to be separated with an ASR score of 60 or 39 months service with 
the exception of MOS categories listed below. 334 

1. Officers in primary and secondary classifications A, B, or C of MOS categories 
3105 Gastro-enterologist, 3107 Cardiologist, 3111 Urologist, 3112 Dermatologist, 3115 
Anesthetist, 3130 Neuropsychiatrist, 3150 Medical Officer, General Surgery, 3180 Physical 
Therapy Officer, 3306 Radiologist, and 3325 Pathologist, must have an ASR score of 60 
or 42 months' service. 

2. Officers in primary and secondary classifications A, B, or C of MOS categories 3106 
Ophthalmologist and Otolaryngologist, 3125 Ophthalmologist, 2126 Otohinolaryngologist, 
3139 Medical Officer, Internist, and 3153 Orthopedic Surgeon, must have an ASR score of 70 
or 45 months' service. 

3. Plastic Surgeons 3152 were not subject to these criteria but were to be reported to the 
Air Surgeon for disposition. 



132 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Dental and Veterinary Corps officers were subject to release with ASR scores 
of 60 or 39 months' service, and Sanitary and Medical Administrative Corps 
officers would be released on ASR scores of 50 or 39 months' service. 

New separations criteria for Medical Department officers were announced 
on 20 December 1945 to become effective 31 December 1945 as follows: 335 

a. Medical Corps officers (Except Group I, Group II, and Group III (below), ASR 65 
or three years six months' service or age 45; Group I officers having primary or secondary 
classifications A, B, or C in the following MOS: 3105, 3107, 3111, 3112, 31 15, 3130, 3150, 
3180, 3306, and 3325-ASR 70 or 3 years 9 months' service or age 45; Group II officers 
having primary or secondary classification A, B, or C in the following MOS: 3106, 3125, 
3126, 3139, and 3153-ASR 80 or continuous active service since prior to 7 December 1941 
or age 45; and Group III officers having primary or secondary classifications A, B, or C in 
the following MOS: 3152 only-ASR 80 or continuous active service since prior to 7 December 
1941 or age 48. 

b. Dental Corps officers: 

( 1 ) ASR of 65 or over or 

(2) Completed 42 months' active military service or 

(3) Age 45 to nearest birthday. 

c. Veterinary Corps officers: 

(1) ASR of 65 or over or 

(2) Completed 42 months' active military service or 

(3) Age 42 to nearest birthday. 

d. Sanitary Corps officers: 

(1) ASR of 60 or over or 

(2) Completed 42 months' active military service or 

(3) Age 42 to nearest birthday. 

e. Medical Administrative Corps officers: 

( 1 ) ASR 60 or over or 

(2) Completed 42 months' active military service or 

(3) Age 42 to nearest birthday. 

f. Army Nurse Corps and Physical Therapists: 

(1) ASR or 25 or over or 

(2) Age 30 to nearest birthday or 

(3) Completed 24 months' active military service or 

(4) Have dependent child or children under 14 years of age or 

(5) Are married or 

(6) Have physical status limited to continental United States. 

g. Medical Department Dietitians: 

(1) ASR of 30 or over or 

(2) Age 35 to nearest birthday or 

(3) Have dependent child or children 14 years of age or under or 



THE WAR MISSION 



133 



(4) are married or 

(5) Have physical status limited to continental United States, 

Retention of Medical Department officers eligible under foregoing criteria 
was to be governed strictly by the following: 

a. All Medical Department officers including Medical Corps officers included in Group I, 
Group II, and Group III, except Regular Army or volunteers who become eligible for 
separation prior to 1 December 1945, will be reported available for separation prior to 
1 January 1946. 

b. All Medical Department officers except Regular Army or volunteers who become 
eligible for separation from 1 December 1945 to 30 December, inclusive, will be reported 
available for separation on or before 28 February 1946. 

c. All Medical Department officers other than Medical Corps officers included in 
Group I, Group II, and Group III, except Regular Army and volunteers who become 
eligible for separation on or after 31 December 1945, will be reported available for separa- 
tion within 60 days of the date upon which they individually become eligible under any 
one of the separation criteria herein announced. 

d. All Medical Corps officers included in Group I, Group II, and Group III, except 
Regular Army and volunteers who become eligible on or after 31 December 1945 will be 
reported available for separation within 90 days of the date upon which they individually 
became eligible under any one of the separation criteria herein announced. 

e. All Medical Department officers included in b above who volunteer by signing a 
category IV statement under the provisions of Section IV Circular 366 WD 45 will be 
reported available for separation on the date of the expiration of the agreed term contained 
in the statement, or 28 February 1946, whichever date is the later. 

f. All Medical Department officers included in d above who volunteer by signing 
a category IV statement under the provisions of Section IV Circular 366 WD 45 will be 
reported available for separation within 90 days of the date upon which they individually 
become or have become eligible under any one of the approved separation criteria herein 
and heretofore announced or upon the date of expiration of the agreed term contained 
in the statement whichever date is the later. 

g. Maximum care will be exercised to avoid retention of any personnel whose services 
are not absolutely essential to the assigned missions. 

Provision was made on 8 January 1946 to alleviate in part the problem 
of the surplus Medical and Dental Corps officers in the major commands. 
Such surplus officers were to be relieved from active duty on an ASR score 
of 60 or 38 months of service, except those officers whose primary or secondary 
classification was in MOS categories 3105, 3106, 3107, 3112, 3125, 3126, 3130, 
3 J 39> 3 I 5°> 3 I 53> 3 x 8o, 3306, 3325. Officers in these categories were required 
to have an ASR score of 70 or 41 months' service to qualify for separation. 336 

It should be noted that the various criteria established for the separation 
of Medical Department officers did not include either officers of the Regular 
Army or graduates of the Army Specialized Training Program. 



134 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



10 

3 
o 



Separation data were available for two periods: V-E Day to V-J Day and 
from V-E Day to 29 January 1946. 337 Data from V-E Day to V-J Day given 
in the table below show that separations were negligible for this period: 

Medical Corps M4 

Dental Corps 14 

Army Nurse Corps 123 

Medical Administrative Corps 

Sanitary Corps 

Veterinary Corps 

Hospital Dietitians o 

Physical Therapists o 

Total 294 

The number of Medical Department officers on duty with the Army Air 
Forces separated during the period from V-E Day to 29 January 1946 (the 
arbitrary cut-off date of this discussion), listed according to the authority under 
which they were separated, is shown in the table which follows: 

Table 4— Number of Medical Department Officers on Duty With the Army 
Air Forces Whose Separations Orders Had Been Received by the Office of 
the Air Surgeon from V-E Day to 29 January 1946* 





MC 


DC 


ANC 


WD Cir. 485 


7 


1 


1 


WD Cir. 485, Sec. Ill 


65 


2 


1 


WD Cir. 485, Sec. IV 


28 


9 


3 


Readjustment Regulations 








1-5 


1, 502 


264 


927 


WD Bulletin 37 and AR 








605-10 


253 


53 


171 


Retired (Physical Disabil- 








ity) 


48 


31 


8 


Miscellaneous 


1, 409 


514 


1, 642 


Deaths 


2 






Resignation Regular Army 








in lieu of reclassification . 


1 




1 


WD Cir. 290, Sec. II 


166 


65 


81 


WD Cir. 290, Sec. Ill 


165 


51 


2 


WD Cir. 290, Sec. IV 


131 


88 


8 


Grand Total, All Personnel 








9058** 


3, 777 


1, 078 


2,845 



MAC 



1 
1 

306 
83 
1 

595 



34 
12 
7 

1, 040 



SC 



30 
6 



55 



5 

13 
1 

113 



VC 



31 
10 



70 



2 
12 
6 
1 

132 



HD 



14 
1 



34 



49 



PT 



3 
2 



19 



24 



*The breakdown according to authority under which officers were separated is only an approximation. 
Orders omitting authority or containing references to more than one authority were automatically placed 
under the miscellaneous category. 

**Data secured from records of Personnel Division, AFTAS. 



THE WAR MISSION 



135 



NOTES TO CHAPTER II 

1 For discussion of different points of view see Kent Greenfield, Robert Palmer and Bell Wiley, The 
Organization of Ground Combat Troops, U. S. ARMY IN WORLD WAR II, (Washington, D. C. U. S. 
Government Printing Office, 1947), pp. 1-38 and 134-142; Mark S. Watson, Chief of Staff: Prewar Plans 
and Preparations, UNITED STATES ARMY IN WORLD WAR II, (Washington D. C. U. S. Government 
Printing Office, 1950), pp. 278-298. See also W. F. Craven and J. L. Cate, Plans and Early Operations, 
THE ARMY AIR FORCES IN WORLD WAR II, (Chicago, 1948) Vol. I, pp. 3-71. 

2 See John D. Millett, The Organization and Role of the Army Service Forces, U. S. ARMY IN WORLD 
WAR II, (Washington D. C. U. S. Government Printing Office, 1954), pp. 297-299; 308-311; 324-325. 

3 Comments of Brig. Gen. A. H. Schwictenberg who was assigned as liaison officer to the Office of the 
Surgeon General. 

4 Ltr., TSG to the Sec. of the WDGS, 3 Jan 42. 
8 AG ltr. 381 (8-13-40), R-A, 3 Feb 1941. 

"The /. A. M. A., "Procurement and Assignment Service for Physicians, Dentists, and Veterinarians," 
Vol. 118, (Feb 1942) pp. 625-640. 
'Ibid. 

8 The original Board was composed of Dr. Frank Lahey, chairman, Dr. James Paullin, Dr. Harvey B. 
Stone, Dr. Harold S. Diehl, and Dr. C. Willard Camalier. 
•AG ltr. 21 0.1 (1-3-42) TB-A, 21 Jan. 1942. 

10 Memo for Col. R. T. Coiner from Col. D. N. W. Grant, 19 May 1942. 

"R&R, TAS for AFAAP, 21 Mar 1942. Col. W. F. Hall stated the original agreement was made by 
him and Col. G. F. Lull, Chief, Pers. Div., SGO. Interview with Col. W. F. Hall by H. A, Coleman. 
17 Feb 1945. 

"Ibid. 

18 Ltr., Col. W. F. Hall to TAS, 2 Apr 1942. 
"See 20 1. 1, Appointment and Procurement. 

"For authority par. 2 of AG Immediate Action Letter, 201.6 (2-28-42) RB, was called to the attention 
of the examining surgeon. 

M Ltr., W. F. Hall, Asst. TAS, to Dr. Louis F. Bishop, 29 Mar 1942. 

" Ibid, Ltr., Col. I. B. March to TAS, 16 Apr. 1942. Reference is made in this letter to grades prom- 
ised and rapid promotions. 

u Ltr., Col. W. F. Hall to Maj. W. F. Dewitt, 29 Mar 1942. 

" Memo for SG from Dir. of Military Personnel, SOS, 12 Apr 1942. 

20 Memo for C/S, Attn G-i from Dir. of Military Personnel, SOS, 22 Apr 1942. 

21 AG ltr. 2 1 0.1 (4-25-42) RE. 
"AG ltr. 210.31 (4-28-42) OF. 

28 Instructions to Medical Officer Recruiting Boards from the SGO. 

34 Memo for Col. R. T. Coiner, Office of the Assistant Secretary of War for Air, from TAS. 
tt Ibid. 

28 Memo for Mr. R. A. Lovett from Colonel R. A. Brownell, 26 May 1942. 

27 Memo for Colonel Greenbaum from Gen. C. C. Hillman, 3 Jun 1942. 

28 Memo for C/S from Dir. of Military Personnel, SOS, 24 Jun 1942. 

80 Memo for MPD, SOS, from AC/S, G-i WDGAP 210-1 (6-30-42). Also AG Letter 210.1 
(6-23-42). RE-SPFAO, 6 Jul 1942. 

81 AG Letter 210.1 (6-23-42) RE-SPGAO, 6 Jul 1942. 

32 Information secured from Maj. C. G. Munns, Personnel Division, Air Surgeon's Office, in an inter- 
view, 24 Feb 1945. Lt. Col. W. H. Miller and Maj. J. Brindle, who were formerly connected with A-i, 
could not recall the recruiting procedure for doctors. However, both were of the opinion that A-i did 
not commission doctors directly. Interview by H. A. Coleman, 23 Feb 1945. 

83 Memo for Col. W. F. Hall, Chief, Personnel Division, Air Surgeon's Office, from Chief Clerk, 
Personnel Division, Air Surgeon's Office. 

84 WD SOS AGO Memo, No. S605-14-42 21 Oct 1942. 
" Ibid. 

M WD Circular No. 367, 7 Nov 1942, par. 1. 



136 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



"Ibid., par. 3. 

38 Memo for the Chief, Field Operations Branch from Col. Robert Cutler, ASC, Chief, Procurement 
Division, 1 Dec 1942. 

89 Ibid., also memo for Chiefs of Supply and Administrative Services, and CG's, AGF and AAF, from 
Col. C. H. Danielson, Director, OPS, 12 Dec. 1942. 

40 Directive from Chief, Field Operations Branch, OPS, SOS, 13 Jan 1943. 

41 Ibid. 

43 Ibid. The following States had already contributed more doctors than the sum of the 1942 and 
1943 quotas: Alabama, Arizona, Delaware, Georgia, Idaho, Kentucky, Louisiana, Mississippi, New Mexico, 
North Carolina, South Carolina, Tennessee, West Virginia, and Wyoming. 

43 AG memo No. W 605-8-43, 22 Feb 1943. 

44 Memo for WD, OPS, from Chief, Personnel Division, AFTAS, 31 Mar 1943. 

46 Address of Maj. Gen. D. N. W. Grant delivered at General Arnold's Conference, Maxwell Field, 
Alabama, 18 Feb 1944. 

48 Memo for Col. Julia C. Ftikke ANC, SGO, from TAS, 22 Sept 1942. 

4T Ltr., Col. Julia C. Flikke to Col. W. F. Hall, 16 Nov 1942. Designated a "section" rather than a 
"division." 

48 Directive, The Surgeon General to the AG, 3 Dec 1 942. 

49 Ibid. 

M Report of the Nursing Section bv Lt. Col. Nellie V. Close, undated. 
61 Ibid. 
a Ibid. 

88 "Annual Report, Personnel Division, Office of The Air Surgeon," fiscal years 1942-43. 
54 Apparently 410 nurses whose papers were processed refused appointment. 
" Public Law No. 828, 77 Cong., 22 Dec 1942, Sec. 2. 
58 AFTAS Letter, 15 Apr 1943. 

"Capt. H. L. Curd, MAC, visited hospitals in Chicago, Indianapolis, Minneapolis, Rochester, St. Paul, 
St. Louis, and New York City, 24 May 1943. 

58 Ltr., Catherine Worthingham, President, American Physio-therapy Association, to Capt. C. G. Munns, 
.7 June 1943. 

59 Ltr., Catherine Worthingham to Capt. C. G. Munns, 23 Jun 1943. 

60 ASF, OPS, FT 88, 7 Jul 1943. 
81 Ibid. 

02 Interview with Maj. C. G. Munns, Procurement Branch, AFTAS by H. A. Coleman, 18 Mar 1945. 
68 See Chapter IV. 

84 R&R, TAS for A-i, 21 Feb 1942. See also R&R, the Research Division, AFTAS, for AC/AS. 
This statement is made: ". . . although the original requisition stated that individuals were desired 
who had a Doctor of Philosophy degree in one of the biological sciences, it was imperative that these 
individuals have sufficient human physiology training to insure their ability to instruct Army Air Forces 
personnel in these matters." 

88 "Scarce Categories of Specialized Skill," 12 May 1943, transmitted to Memo No. W605-23-43, 
1 5 May 1943. 

00 Memo for C/S from TAS, 24 Feb 43. 

B7 /W. 

88 Ibid. 

88 R&R AFTAS for AFAAP, 11 Jun 1942. 
,0 Ibid. 

71 R&R; AFTAS for AFAPA (Appointment and Procurement). 9 Sep 1942. 

"Par. id, in AG 210.1 (9-20-42) BM-SPGAO. 

n Memo for the CG, AAF, from Henry L. Stimson, 29 Aug 1942. 

74 Memo for the Secretary of War's Personnel Board, OPS, CG's, AGF, ASF, AAF, and Divisions of 
WD General Staff, 13 Oct 1943. 

n RR from AC/AS, Personnel, to TAS, 19 Oct 1943. 
74 Data taken from records of Research Division, AFTAS. 
" Aviation Physiologists Bulletin, 16-21, AFTAS, Jul 1944. 



THE WAR MISSION 



137 



"According to Miss C. A. Martin, Research Division, AFTAS, there were only about six Medical 
Corps officers in the program as of 29 March 1945. Interview by H. A. Coleman, 29 Mar 1945. 

n Major General Lull and Lieutenant Colonel Paden represented the SG, while Colonel Rusk and 
Major Munns represented TAS. 

80 Ltr., Col. W. S. Jensen, Acting Air Surgeon to TSG, 21 Mar 1944. 
S1 Memo for AC/S from G-i through CG, ASF, 9 Jun 1944. 

82 1st Memo Ind., 12 Jun 1944. 
88 See n. 81. 

84 Specification Serial No. 5521, Inc. 4> Ibid, 
"ibid. 

60 Ltr., Col. W. S. Jensen, Actg AS to TSG, 21 Mar 1944. 

87 Interview with Maj. D. A. Covalt, Convalescent Services Division, AFTAS by H. A. Coleman, 2 Apr 
1945. See also 1st Ind. (Col. H. A. Rusk to CG, ASF, Attn: SGO, 20 Dec 1944) to AC/S, G-i, from the 
SGO, 2 Jan 1944. 

* Ltr., from Col. H. A. Rusk to CG, ASF, Attn: SGO, 2 Jan 1944. 

88 Ibid. 

90 1st Ind. (Col. H. A. Rusk to CG, ASF, Attn: SGO, 2 Jan 1944) SGO to AC/S, G-i through SG, 
ASF, 2 Jan 1945. 

81 Tab A, Job Description and Qualifications for Physical Reconditioning Officers, Ibid. The basic 
change in the job description was the reduction from 10 to 5 years of experience, and the elimination 
of the Ph. D. degree, However, the original job description required either an M. A. or a Ph. D. degree. 

83 Ltr., AG to CG, AAF, 1 8 Jan 1 945- 

H3 Telephone conversation with Capt. Jessie M. Shroyer, Personnel Division, AFTAS by H. A. Coleman, 
1 1 Apr 1945. 

** Form 66-2, in AAF Records Section, Military Personnel. 

1,5 Memo for the C/S from Maj. J. C. Flanagan, Dec 1941. Colonel Flanagan was doubtful whether 
this study was ever sent to the Chief of Staff. Interview, 1 1 Apr 1945. 

88 Apparently the allotment was approved by A-i instead of being sent to G-i. 

"Interview with Col. J. C. Flanagan, Psychology Branch, AFTAS, by H. A. Coleman, 11 Apr 1945. 
88 Ltr., AC/AS Personnel, to the AG, 17 Nov 1944. 
88 Memo for TAG from G-i, 9 Dec 1944. 

100 Interview with Col. P. M. Fitts, 17 Apr 1945. 

101 Ibid. 

102 Memo for the members of the Aviation Psychology Program from Col. J. C. Flanagan, 27 Jan 1945. 

103 The "66-2" records were incomplete. 

104 There was no record of one officer. 

108 Interview with Gen. Grow by M. M. Link 1953. 

100 Report of the Committee to study the Medical Department of the Army, 1942. Commonly re- 
ferred to as the Wadhams' Committee Report. 

10T Interview with General Howard Snyder by M. M. Link, 15 Jan 54. 
108 As cited, Meihng Remarks and verified by General Grant, 1953. 
108 Interview with General Grant by M. M. Link, 1 6 Sep 53. 

110 C/AS to AAF, 28 Feb 1943, "Consideration of non -concurrence" of The Surgeon General (Memo 
for C/S from C/AS, 7 Oct 1942). 

111 Memo for C/S from the Air Staff, 7 Oct 1942. 

112 Memo for the CG, SOS, from TSG, 13 Oct 1942. 
118 Memo for CG, AAF, from CG, SOS, 15 Oct 1942. 
**Ibid. 

118 C/AS to AAF, 28 Feb 1943, "Consideration of non-concurrence" of The Surgeon General (Memo 
for C/S from C/AS, 7 Oct 1942). 
Ufl Ibid. 

117 Memo for G-i, G-3, OPD, CG's, AAF, AGF, ASF, from GO-4, 4 May 1943. 
Memo for G-i from CG, AGF, 25 Feb 1943. 

118 Memo for G-i from CG, SOS, 27 Feb 1943- 
130 Memo for G-4 from G-i, 16 Mar 1943. 



138 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



131 Memo for G-i, G-3, OPD, CG's, AAF, AGF, ASF, from G-4. 

133 "Brief of Tabs," prepared by G-4. 
123 Tab G, WDGAP/354.7 (2-8-43)- 

134 Memo for the C/S from G-i. 

w Memo for the CG's, AAF, ASF, AGF, from the C/S, 9 Jul 43- 

136 Ibid., par. 5. 

137 AAF Memo No. 20-12, 18 Sep 1943. 

128 1st Ind. (basic unknown), SGO to CG, ASF, 12 Apr 1943. 

129 At least, it was not among the inclosures to the G-4 study of 1 5 Jun 1 943. 

™° Memo for General Styer from General Lutes, 14 Mar 1943. 

331 Memo, for C/S from CG, SOS, 30 Apr 1943. 

*" Extensive search failed to locate these letters. (Editor's note). 

183 See n. 131. 

134 Appointed 10 Sep 1942. Appointment, instructions, and extracts from Committee report, ibid. 

Undated memo, TAS for General Arnold. 
U6 Memo for Maj. Gen. Brehon Somervell, CG, ASF from Maj. Gen. Leroy Lutes, 30 Apr 1943. 
m Memo for the CG, ASF, from Gen. Barney M. Giles, Acting CA/S, 25 May 1943- 

138 Memo for the C/S from the G-4, 15 Jun 1943. 

"•General Somervell made this comment concerning this statement: "It is based entirely on the 
assertions of the Air Surgeon." He also thought other statements in the memorandum of G-4 were 
"more matters of opinion rather than fact." Memo for the C/S from General Somervell, 30 June 1943* 

140 Italics by historian. Memo for the CG's, AAF, AGF, and ASF, from DC/S, 20 Jun 1943. 

141 Presumably the facts surrounding this event will be discussed in the history of the Army Surgeon 
General in preparation. 

143 Memo for the CG's, AAF, AGF, and ASF, from Deputy C/A; 20 Jun 43, and Ibid., "Corrected Copy." 
9 Jul 43- 

143 As cited from AM A records by Dr. George F. Lull (M. D.) Secretary and General Manager, AM A, in 
ltr. to Maj. Gen. Grant, 9 Oct 53. This information together with copy to Sec. of War was in answer to a 
request by Mae M. Link. 

144 WD Cir. No. 165, 19 Jul 1943- 

148 WD Cir. No. 304 Amendment, 22 Nov 1943, "4a . . . This type of surgery will include operations 
on the gastro-intestinal tract with the exception of appendectomy, operations on the bilary tract, operations 
on the genito-urinary tract, including gynecological operations on military personnel operations on the 
central nervous system, including those for herniation of the nucleus pulposus, operations on the neck, 
all plastic operations except skin grafting, operations on the thorax except closed drainage of empyema, 
operations on the breast, all operations for suspected malignancy, and all major amputations, b. Included 
in this category also are major operations on joints, internal fixations of fractures, bone grafting, and 
operations for bunions. Other types of cases considered in this category are fractures of facial bones, 
compression fractures and dislocations of the vertebrae, fractures of the pelvis, and fractures of the shaft 
of the long bones." 

146 Memo for CG, AAF, from TAS, 29 Nov 1943. 

147 Paraphrase from portions of Memo, Arnold for Marshall, 26 Dec 43. 

148 Memo for WDGS-G-i from Gen. Giles, 2 Dec 1943. 

149 WDGAP/701 AG 704.11 (2 Dec 43), 3 Dec 1943. 

1D0 SPG A A 705 Gen (3 Dec 43) 31 AG 704.11 (2 Dec 43), 5 Dec 1943. 
161 Memo for Director, MPD, ASF, from SGO, 9 Dec 1943. 

Ma WD Cir. No. 316, par. 3 b and c, 6 Dec 1943. See also WD Memo No. W 4 o-i4-43' 28 May 1943. 

353 These representatives of the Air Surgeon were: Colonel Holbrook, Colonel Chenault, and Major 
Shands. Colonel Holbrook, in an interview 28 Dec 1944, said that the representatives of the Air Surgeon 
did not concur, and, furthermore, that not all the subject matter of the circular was discussed at the meeting. 
Colonel Shands corroborates the statement of Colonel Holbrook. 

184 MPD, ASF> to G-i, in AG 704.11 (2 Dec i943)> *3 Dec 1943- 
WD Cir. No. 12, 10 Jan 1944. 

1M Col. Schwichtenberg had previously been on duty as Commander at Westover Fid, Mass. 



THE WAR MISSION 



139 



u: Memo for CG's AAF, and AGF from Deputy C/S, 9 Jul 43. 

158 ASF Circular No. 296, 1944* Sec. II, Part 2, par. 4, as quoted in AAF Ltr., 21 Sep 44. 
U9 See the chapters in this volume dealing with the Theaters, 

160 Memo for General Giles from General Grant, 29 Nov 43. 

161 Comment 2, (basic above), TAS to Asst. C/AS, Personnel, 6 Dec 43. 

,rt -R&R, Col. H. C. Chenault (MC) Executive Officer, TAS, to Asst. C/AS (OC&R), sub: Air Base 
Hospitals for Overseas Air Bases in 1944 Army Air Forces Troop Basis, 13 Dec 43. 

183 See "Study of Overseas Hospitalization," prep'd by Lt. Col. R. C. Love. No copy of the memo o£ 

6 Feb 1944 could be found. 

564 Ibid. 

lfiS Draft memo, Arnold for Marshall, sub: Medical Care of Army Air Forces Personnel. 

169 See n. 163. 

167 Memo for Colonel Welsh from Maj. John S. Poe, 28 Feb 44. 

168 Memo for Gen. H. H. Arnold from Lt. Col. Robert Proctor, 29 Feb 44. 

1W Informal conversation. Admiral Ross T. Mclntire, USN (Ret) and Mae M. Link, 16 Sep 53. 

170 Ibid. 

171 1. Statement of Dr. Richard L. Meiling to Mae M. Link. 2. Marshall's written instructions were con- 
tained in a memo for Arnold and Somervell. Col. Jensen and Dr. Meiling prepared Arnold's answer. 

173 This summary incorporates statements of Dr. Richard Meiling and reflects in part the statements of 
Hrig. Gen. Schwictenberg. 

173 Memo for General Marshall from Franklin D. Roosevelt, 28 Feb 42. 

174 Memorandum Report signed Norman T. Kirk, Maj. Gen., USA, TSG, Mai. Gen. N. W. Grant, USA, 
TAS, US AAF and Edward A. Strecker, M, D., for the C/S through the Deputy Theater Commander, 
ETOUSA, 20 Mar 44. 

175 Ibid. 

178 Interview with Brig. Gen. Richard Meiling by Mae M. Link, 1953. 

177 AG ltr., to CG's AGF, AAF, SOS, 18 Jun 1942; Ltr. included other commanders. 

178 Memo for the DC/S from the CG, ASF, concurred in by the Deputy Surgeon General and TAS> 

7 Jun 1944. 

179 Army Air Forces Regional Hospitals: 

1. Westover Field, Mas? 17. Amarillo Army Air Field, Amarillo, Tex. 

2. Mitchel Field, N. Y. 18. Barksdale Field, La. 

3. Langley Field, Va. 19. San Antonio Aviation Cadet Center, San Antonio, 

4. Army Air Forces Regional Station Hos- Tex. 

pital No. 1 . 20. Sheppard Field, Tex. 

5. Drew Field, Fla. 21. Davis-Monthan Field, Ariz. 

6. Greensboro, N. C. 22. Hammer Field, Calif. 

7. Keesler Field, Miss. 23. Kearns Field, Utah. 

8. Maxwell Field, Ala. 24. Santa Ana Army Air Base, Santa Ana, Calif. 

9. Orlando Army Air Base. 25. Smoky Hill Army Air Field. 

10. Patterson Field, Ohio. 26. Pyote Army Air Field, Pyote, Tex. 

ri. Chanute Field, 111. 27. Hamilton Field, Calif. 

12. Scott Field, 111. 28. Eglin Field, Fla. 

13. Traux Field, Wis. 29. Hunter Field, Ga. 

14. Buckley Field, Colo. 30. Robins Field, Ga. 

15. Lincoln Army Air Field, Lincoln, Nebr. 

16. Sioux Falls Army Air Field, Sioux 

Falls, S. Dak. 

180 Published 6 Jun 1944, in AAF Letter 35-96, Personnel Strength Tables for AAF Medical Depart- 
ment Personnel in Hospitals in ZI. 

M1 Memo for the CG's, ASF, and AGF, WDCSA/632 (9 Jul 1943)- 

182 AFS Circular No. 296, 1944* quoted in AAF Letter 25-1, 21 Sep 1944. 

183 Ibid. 

184 From TAS, in 701, Medical Attendance. 
262297°— 55— 11 



140 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



lw Information furnished by Capt. M. D. Whiteside, Hospital Section, Operations Division, Air Surgeon's 
Office, 9 Jan 1945. 

188 As of 18 Ju! 1944. Data furnished by Col. A. A. Towner, Chief Hospital Section, Operations 
Division, Air Surgeon's Office. 

187 WD Cir. No. 140, 11 Apr 1944. 

1M Change No. 3 in AR 40-1080, 30 Sep 1944. 

U9 Memo for the Air Surgeon from Lt. Col. Lee C. Gammill, Chief, Hospital Construction, Air Surgeon's 
Office, 16 Oct 1943. 

190 Memo for CG's, AAF, ASF, AGF, from AC/S, G- 4 , Sep i 9 44- 

191 Memo for TSG from Director of Plans and Operations, ASF, 23 Sep 1944. 

1M Memo for the CG, ASF, from Director of Plans and Operations, ASF, 23 Sep 1944. 

M Par. ib, 2, and 3. 

194 Change 3, 20 Sept 1944- 

196 Memo for TSG from Director of Plans and Operations, ASF, 11 Oct 1944. 

196 Memo for CG's, ASF, and AGF, and from AC/S, G-4, 23 Sep 1944. The directive made no 
distinction in the type of facility where the reduction would be effective. 

191 Memo for the AC/S, G-4, from Director of Plans and Operations, ASF, 30 Oct 1944. 
108 Memo for the CG's, ASP and AAF, from G-4, 17 Nov 1944. 

199 Memo for TSG from Acting Director of Plans and Operations, ASF, 7 Dec 1944. 

200 Memo for CG, ASF, from TSG, 4 Jan 1945. 

201 Memo for the CG, ASF, from TSG, sub: "General Hospital Program, Zone of the Interior," 8 Jan 
I945- 

202 DF WDGDS 7623 to CG, ASF, from AC/S, G-4, 20 Jan 1945. 

203 Memo for TSG, from Director, Plans and Operations, ASF, 22 Jan 1945. 
Mi Par. 3. 

206 Par. 4. It should be noted that the shortage of hospital beds is not in station and regional hospitals 
where prior reductions had been ordered by G-4. 

206 Memo for the CG, AAF, from G-4, 1 1 Jan 1945. 

207 Memo for AC/S, G- 4 , from TAS, 13 Feb 1945. 

308 This information was taken from "Memorandum for the Record," 5 Mar 1945, written by Col. 
W. P. Holbrook. 

209 Ibid. 

210 Memo for CG, ASF & AGF from G-4, 27 Feb 1945. 

211 "Memorandum for the Record," TAB C, 2 Mar 1945, prepared by Lt. Col. R. B. Rutherford, Special 
Assistant to TAS. 

212 Ibid, TAB D. 

LM:t Memo for TSG and TAS, Tab G, in ibid. A note on this memo states that it was initialed on 
6 March by Colonel Fitzpatrick, Colonel Stewart, Lieutenant Colonel Thompson, and Major Gay, representing 
TSG, and Colonel Holbrook, Lieutenant Colonel Towner and Major Ball for TAS. For details, see: 
Tab E, "Memorandum for the Record," 5 Mar 1945, signed by Lt. Col. Alonzo A. Towner, AFTAS; 
Tab F, "Memorandum for the Record," 5 Mar 1945, signed by Lt. Col. R. B. Rutherford, AFTAS. 

214 Memo for AC/S, G-4, from TAS, date unknown. 

218 DF, Comment No. 1, to CG, AAF (Attn: Air Surgeon), from G-4, 26 Mar 1945. 

- lft Memo for the DC/S, sub: Report of Survey of Zone of Interior Hospitalization, 14 May 1945, 

217 Par. 7 a. 

2U Par. 7 f and g. 

2lD Transmitted 21 May 1945, Report of Zone of Interior Hospitalization, from G-4, copy in C/S 
Records Room. Noted by DC/S, 23 May 1945, and by C/S, 24 May 1945. According to General 
Schwichtenberg, it was out of the rehabilitation and conversion program described that the hospital center 
concept emerged. A hospital center consisted of a large general hospital (Specialized Hospital) plus a 
convalescent hospital. Some centers came to have as many as 10,000 beds altogether. 

220 Questionnaires and answers on file in TAS files. See also "Hospitalization for AAF Units Overseas." 

231 Copies (stayback) of letters to theater air surgeons, AFTAS files. 

" 2 Memo for AC/AS, OC&R, Integration Committee, from Lt. Col. Richard L. Meiling (MC) Acting 
C/Operations Div., 10 Jun 44. 



THE WAR MISSION 



141 



222 Memo for C/AS from General Grant, 26 Jun 44. 

^Comments 1 through 8 (basic above), 30 Jun 44 through 23 Jul 44, sub: AAF Medical Service and 
Hospitalization Overseas, and penciled notation on office buck slip bearing Gen. Timberlake's name and with 
his initials. 

225 Penciled note for Col. Bair (TAS) initialed RLM (Richard L. Meiling). 
■^Comment 11 (basic above), TAS to OC&R, 28 Jul 44. 

227 Comment 14 (basic above), AC/AS, OC&R to Deputy C/S, 9 Aug 44. Comment 15, Deputy 
C/S to TAS, 12 Aug 44. 

as TWX Msg, Saunders to Grant, 13 Jul 44. 

220 See p. 106. 

"° /. Comment 16, TAS to Deputy C/S (basic above), 23 Aug 44. 2. Basic study bears marginal note 
"Disapproved by Gen. Arnold 9/1/44. (Initialed) BMG (General Giles)." 

m AG ltr. to CG's, AAF, ATC, EDC, NBC, and North Adantic Wing, ATC, 6 Aug 1943. 

222 Par. 7, OPD, WDGS, DF, 6 Mar 44. 

223 Par. 2, DF from G-3 to CG, AAF, 18 Mar 1944. 
™lbid. 

DF from AAF to G-3, 5 Apr 1944. 

2,7 DF from G-3 to CG, AAF, 18 Apr 1944. 
m DF from AAF to G-3, 26 Apr 1944. 

AG ltr., dated 1 1 May 1944 on basis of DF from OPD to TAG, 9 May 1944. 

140 DF from G-3 to CG, AAF, 17 May 1944. 

141 Memo for TSG from General Lutes, 24 May 1944. 
842 Memo for TSG from General Lutes, 20 May 1944. 

243 1st Ind. (basic ltr., TSG from CG, ASF, 24 May 1944) 2 Jun 1944, taken from Memo for Record. 

244 Memo for AC/S, G-3, from CG, ASF, 16 Jun 1944. 

*" Memo for C/S, Attn: OPD, undated. 

248 Memo for CG, ASF, from G-3, 24 Jun 1944. 

247 R&R from TAS to Management Control, 31 Jul 1944. 

148 Ibid. 

149 Ibid. 

180 Comment No. 4, R&R from Air Judge Advocate to AC/AS, OC&R. 

181 Comment No. 5, R&R from AC/ AS, OC&R to TAS. 

282 DF to OPD, G-3, TAG, from AC/AS, OC&R, 30 Aug 1944. 

283 1 st Ind. (DF from OPD to CG, ASF, 2 Sep 1944), from TSG to OPD, through CG, ASF, 5 Sep 
1944, Memo for Record. 

254 2d Ind. (DF from OPD to CG, ASF, 2 Sep 1944), from CG, ASF, to AC/S, OPD, 7 Sep 1944. 

285 Memo for CG, AAF, from OPD, 10 Sep 1944. See also R&R from AC/ AS, OC&R, to TAS, 
1 1 Sept 1944 and comment No. 2 from TAS to AC/ AS, OC&R, 16 Oct 1944- 

286 AG ltr., to CG's AAF, Eastern Defense Command, and ATC, 7 Nov 1944. 

257 Ltr., CO, SAD, ATC, to CG, AAF, through CG, ATC, 9 May 1945. 

258 1st Ind. (basic ltr., CO, SAD, ATC, to CG, AAF, through CG, ATC, 9 May 1945) > Hq. ATC, 
to CG, AAF, 16 May 1945. 

2d Ind. (Basic ltr., CO, SAD, ATC, to CG, AAF, through CG, ATC, 9 May 1945). from Hq., AAF, 
to OPD, 30 May 1945. 

280 DF from OPD to CG, ASF, Attn: TSG, 1 Jun 1945. 

281 1st Ind. (DF from OPD to CG, ASF, 1 Jun 1945), TSG to OPD, 8 Jun 1945. 

283 Ltr., AFTAS to CO, SAD, ATC, 20 Jul 1945. 

288 Memo for the Sec. of War from the TSG, 10 Jan 1945. 

284 Ibid. 

288 Memo for the AC/S, G-i, G-3, G-4, and OPD, CG's, AAF, AGF, and ASF, from ADC/S, 
13 Jan 1945. 

288 Memo for the AC/S, G-i, from Gen. Barney Giles, 15 Jan 1945. 

*" Memo for Major General Grant, TAS, from Lt. Col. R. B. Rutherford, 24 Jan 1945. 



142 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



288 Memo for Major General Grant, TAS, from Lt. Col. R. B. Rutherford, 10 Feb 1945. 
™Ibid. 

270 WD Cir. No. 59, 2 Mar 1942. 

,T1 DF, to (d) CG, ASF (2) C/S from SPMDA, General Lull 29 Jan 1945. 

272 Ibid. 

273 Italics by historian. 

274 Italics by historian. 

275 Italics by historian. 

276 Comment No. 2 to G-i, WDGS, from Hq., AAF, 14 Feb 1945. 

277 Comment No. 4 to G-i, WDGS, from Hq., AAF, 2 Mar 1945. 

278 Memo for Lt. Rutherford from G-i, 9 Mar 1945. 

279 Telephone conversation between Brig. Gen. F. A. Bliss, SGO, and Lt. Col. R. B. Rutherford, TAS. 
2 Mar 1945. 

280 Memo for Maior General Grant, TAS, from Lt. Col. R. B. Rutherford, 12 Mar 1945. 

281 Draft of circular by SGO, par. 2b. 
- s2 WD Cir. No. 120, 18 Apr 1945. 

283 See n. 42. In many of these States the situation was extremely critical. 

284 Daily Report of Activities, Personnel Division, AFT AS, 13 Apr 1945. 

285 RR 1-5, 30 Apr 1945, par. 3b. 
288 Ibid., par. 8a. 

287 Ibid., par. 9 b (1). 

288 Ibid., par. 8a. 

288 Ibid., Appendix I. 

2W Ibid., par. 4a (2). The Adjusted Service Rating score as later announced by the War Department 
was based on (1) one point for each month of service since 16 Sep 1940; (2) one point for each month 
of overseas service since 16 Sep 1940; (3) five points for decorations and bronze service stars awarded for 
service since 16 Sep 1940; and (4) 12 points for children under 18 years old up to three. Points stopped 
accumulating after 2 Sep 1945. Announced by cable No. 79214 from OPD to theaters 8 May 1945. See 
also Memo for C/S from Maj. Gen. R. E. Porter, 13 Aug 1945. 

291 Ibid., Appendix I. A. The formula for competing efficiency indices was E—RxM, with E=Efficiency 

index. R= Rating value (ranging from superior to unsatisfactory). M=Number of months for which 
each rating was given. T~ Total number of months for which rating is available. 

292 ASF, SGO, Office Order No. 105, 11 May 1945. It was necessary to change the personnel of this 
Board because of separations of individual members. 

293 Ibid. 

294 Daily Report, Personnel Division, AFTAS, 16 May 1945* 
205 Memo for CG, AAF, from TAS, 28 May 1945. 

298 Comment No. 1, R&R, from Lt. Gen. Ira C. Eaker to TAS. 
297 Data taken from records of Personnel Division, AFTAS. 

288 TWX, DGT 142057, to CG's all Commands, etc., from AFTAS. 

299 See No. 298. 

300 "Daily Reports of Activities, Personnel Division," AFTAS, 26 Jun 1945. 

301 DF from G-i to CG, AAF, 25 Jul 1945. 

802 Ibid. 

803 If the ratio of 8.3 for the AGF and ASF was arrived at by including the Army Service Forces 
doctors in the general hospitals, then the comparison is ill-advised and unfair. For to balance the large 
number of patients coming into the Army Service Forces general hospitals from the theaters would be a 
small number of admission to the Air Forces convalescent hospitals. 

804 Ltr., AFTAS to CG, ATC. The same information was sent to other commands. 
808 Referred to hereafter as ASR score. 

1,00 SGO listed Otorhinolaryngologist instead of Otolaryngologist. 

807 Ltr., ASF to CG's, Service Commands, 19 Aug 1945. The same criteria were announced on 
13 Aug 1945 in an AG Letter to CG's, EDG, WDC, Director Selective System. 



THE WAR MISSION 



143 



308 TWX DTG 142057, TWX AFTAS 3580 dated 26 Jul 1945. TWX DTG 072122Z, TWX, DI G 
072103Z, and TWX DTG 0721 21 Z. 

**Ltr., Acting C/AS, to CG, CAF, 25 Aug 1945. 

310 Memo for the CG, AAF, Attn: TAS, from Brig. Gen. R. W. Bliss, SGO, 4 Sep 1945. 

311 Memo for AC/S, G-i, from Brig. Gen. R. W. Bliss, SGO, 10 Sep 1945. 

312 Ltr., Service Commands, from ASF, 15 Sep 1945. 

3U Memo for AC/AS-i from Lt. Col. William A. Glazier, 22 Aug 1945. 

814 From V-E Day to V-J Day only 144 doctors and 14 dentists on duty with the AAF had been 
separated it will be recalled. 

315 Ltrs., Maj. Gen. G. V. Henry, Asst. CS G-i, to TSG and TAS, 14 Sep 1945. 
81fl Ltr., Gen. T. T. Handy, Deputy CS, to General Eisenhower, date unknown. 

317 Ltr., General Grant to General Henry, 17 Sep 1945. 

318 Ltr., Ma). Gen. G. F. Lull to CG, AAF, Attn: TAS, 20 Aug 1945. 

319 Ltr., Deputy TAS, to CG, ASF, Attn: Chief, Personnel Division, SGO, 20 Nov 1945. 

320 1st Ind. (basic Ltr., Deputy TAS to CG, ASF, Attn: C/Personnel Division, SGO) to CG, AAF, 
Attn: TAS, 20 Nov 1945. 

821 WDGAP, 16 Oct 1945, AC/S, G-i. Dispatched by TWX to CG's, EDC WDC. See WD Cir. 376, 
1945, Sec. IV, par. 3B for authority. 

823 WD Cir. 485, Sec. Ill, par 8a, 29 Dec 1944. 

823 Ltr., Acting TAG to CG's, AAF, AGF, ASF and S/W Separations Board. 

324 Interview with Miss Anne M. Cauti, Chief Clerk, Personnel Division by H. A. Coleman, 5 Jan 1946. 

325 Interview with Col. G. C. Bulla, C/Personnel Division, AFTAS by H. A. Coleman, 7 Jan 1946. 

326 Memo for G-i from the Deputy Chief of Air Staff, 26 Oct 1945. 

827 Criticism came from Senator George A. Wilson (Iowa). Apparently, this criticism was caused by 
failure of the AFTAS Personnel Division to note that the Secretary of War's Separations Board had reversed 
the decision of The Surgeon General's Separations Board concerning a constituent of Senator Wilson. 
Information obtained from Miss Cauti, Chief Clerk, AFTAS Personnel Division, 5 Jan 1946. 

828 Concerning morale, it should be noted that each Medical Department officer on active duty was 
entitled to the same procedure, i. e., a final consideration of his application by the Secretary of War's 
Personnel Board should it be disapproved by Hq., AAF. 

329 DF to S/W Separations Board from AC/S, G-i, 30 Oct 1945. 

830 Memo for AC/S, G-i, from S/W Separations Board, 5 Nov 1945. 

831 DF to CG, AAF, from AC/S, G-i, 8 Nov 1945. 
332 DF from MPD, ASF, to TAS, 19 Oct 1945. 

833 AG Letter 370.01 (31 Oct 1945) OB-S-A-M., 7 Nov 1945, to CG's, AAF, AGF, ASF. 
33 *TWX No. 1845 from AFTAS to AAF Commands, 17 Dec 1945. These criteria are in effect as of 
31 Jan 1946. 

836 TWX No. 2165 from AFTAS to CG's, AAF Commands, 20 Dec 1945. Length of service as used 
herein included total active commissioned and enlisted honorable service continuous or interrupted since 16 
Sep 1940 and continued to accrue with the passage of time. Time lost under AW 107 was not included. 
ASR score was the score computed for each individual as of 2 Sep 1945. Age was determined to the 
nearest birthday. 

336 TWX No. 665 from AFTAS to AAF Commands, 8 Jan 1946. 

337 The arbitrary cut-off date of this chapter. 



Chapter III 



SCHOOL OF 

AVIATION MEDICINE 
AND RELATED PROGRAMS' 




During the decades following establishment of the School for Flight 
Surgeons at Mineola in 1918, the special problems of aviation medicine were 
matters of continuing concern to the Air Service, the Air Corps and the Army 
Air Forces. Prior to 1934 when the Aero Medical Laboratory was established 
at Wright-Patterson Air Field all aeromedical research activities were by- 
products of advanced study programs at the School and largely a matter of 
individual effort. Both the research and study aspects of aviation medicine 
were curtailed by lack of appropriated funds to provide personnel and facilities. 
From the early days at Mineola through the World War II period, however, 
the requirements of aeromedicine crystallized as a corollary to the development 
of civilian and military aviation. 2 

After World War I the Laboratory at Mineola was reorganized, and 
the officer personnel, all temporary, replaced by officers from the Regular 
Corps. The enlisted personnel, also temporary and of college grade in educa- 
tion, could not be replaced except by civilians. The rapid demobilization thus 
created an acute personnel problem. The Air Service had early recognized the 
need for trained medical officers and as the demobilization went on, calls came 
for more flight surgeons. 

In January 1919 Maj. L. H. Bauer was ordered to command the Research 
Laboratory. He later stated: 3 

I had been there, I think, about two months when I received a long distance telephone 
call telling me they were sending along a class of students; all the other personnel were 
Reserve Officers. They decided to put the Board and Laboratory on a permanent status, 





[144] 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



145 



which is how I happened to go up there and after about two months they wanted to start 
a School of instruction to train flight surgeons for the Regular Army. . . . We had no 
School, no set course, nobody knew what to teach or how long or anything. Neither did 
I know how many students we were going to have. I called in the heads of the various 
departments and we outlined courses of instruction which we thought would be satisfactory. 
The first class was in May 1919. 

That first class was 2 months in length. The name of the School at this 
time was "The Medical Research Laboratory and School for Flight Surgeons." 

On 25 April 1919, Circular Letter No. 189, Office of The Surgeon General, 
described the need for the permanent establishment of the position of flight 
surgeon. 4 Volunteers were requested for training and those accepted were sent 
to the Medical Research Laboratory in groups of 5 to 15 for a 2-month special 
course. 5 In November 1919 the School, along with the Laboratory, was moved 
to Mitchel Field, L. I. The mission of the School at this time was 6 

to train officers of the Medical Corps in the duties of Flight Surgeons; to instruct them in 
the principles and techniques of the physical examination for flying, of the Altitude Classi- 
fication Examination, of Personality Study, of Physical Tests of Efficiency; to familiarize 
them with the general subject of Aviation Medicine particularly with reference to Physio- 
logical, Psychological and Clinical EfTects of Altitude; to instruct them in the care of the 
Flyer and the means of reducing aviation accidents; to train them in the application of 
certain medical specialties to Aviation Medicine; to train graduates of the School in the 
special lines of work in Aviation Medicine for which they are qualified; to train enlisted 
men of the Medical Department as Assistants to Flight Surgeons. 

The School was also to make recommendations for improving the efficiency of 
aviation in general and the flight surgeons in particular. While the School 
was separate from the Laboratory it was operated by the personnel of the 
latter so that organizationally they were considered together. The depart- 
ments were responsible for research in their respective specialties, for instruction 
in the School, and for the routine work assigned them. 7 

The School of Aviation Medicine 

In February 1921, General Order No. 7, Section 7, War Department, rec- 
ognized the School for Flight Surgeons as a Special Service School, and the 
School, which had started as an adjunct of the Laboratory, was now equally 
important. 8 On 8 November 1922 the name of the School was changed to "The 
School of Aviation Medicine." As a Special Service School it was now exempt 
from the jurisdiction of the Corps Area Commander and was directly under 
the Chief of Air Service. Its position in regard to the Commanding Officer of 
Mitchel Field was clarified when it was decided that his jurisdiction should 



148 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

cover "discipline, sanitation and police." Administrative control included 
buildings and quarters assigned to the School or its personnel. The Command- 
ing Officer at Mitchel Field was authorized to grant all leaves of absence and 
correspondence was addressed through that Headquarters. 

Added to the irreparable loss of the records at the time of the Laboratory 
fire in 1921 was the loss of other records in Washington. Dr. I. H. Jones 
later wrote: "I went to the Air Service — found that everything whatsoever of 
the War had been completely destroyed, sabotaged is a better word, except 
the Laboratory data at Mineola which was preserved intact. This occurred 
after General Lyster, Col. E. R. Lewis and all of us had left for civilian life in 
1919." 9 The School burned on Sunday; didactic and clinical work was begun 
on Monday. The class missed nothing as originally planned except the prac- 
tical work in the low-pressure chamber and in orientation. 

The basic course for flight surgeons was inaugurated in May 1919 as 
a 2-month course of instruction in ophthalmology, otology, physiology, 
cardio-vascular disease, psychology, neuropsychiatry and physics. 10 In 1920 
when officer personnel available for teaching was cut from 13 to 5, otology and 
ophthalmology were combined, physics was no longer a separate department, 
and much of the teaching load was taken over by civilians. The course of 
study in 1922, after the reorganization by AR 350-105, provided for the follow- 
ing departments: Aviation physiology, aviation medicine, neuro-psychiatry, 
ophthalmology and otology, aviation psychology and, for instruction only, 
administration. 11 The course had been extended to 3 months in 1920; to 3 
months 10 days in 1923; and then, in 1924, reduced to 3 months, in order to 
accommodate the Reserve officers who took the basic course. With the ex- 
ception of changes as indicated below the course of study was remarkably 
stable during the period 1920-1926. 12 



Table 5. — Course Hours Schedule 



Year 


Physi- 
ology 


Psychol- 
ogy 


Neuropsy- 
chiatry 


Ophthal- 
mology 


Otology 
adminis- 
tration 


Aviation 
medicine 


Cardi- 
ology 


Library 


1921 


90 
90 
52 


45 
45 
40 


75 
75 
73 


90 
90 
89 


20 
20 
22 


75 
75 




25 
25 


1924 




1927 


64 









The subject matter of the courses which did not undergo great change 
is described in some detail. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



149 



The aviation physiology course was presented during the entire period by 
Dr. E. C. Schneider, who did most of the lecturing and who brought to this 
course a background of extensive research and practical experience. Lectures 
covered the general physiological aspects of aviation; physiological effects of 
climatic factors other than altitude; laws of respiratory absorption and dissocia- 
tion; the demand for oxygen and rate of oxygen consumption; anoxemia, clas- 
sification and methods of producing each kind ; altitude sickness and the symp- 
toms of other low oxygen experiences ; the compensations to low oxygen, with 
comparisons to the temporary and permanent varieties of reaction in respira- 
tion, blood, hemato-respiratory function of the blood, circulation, and metab- 
olism; physiology of muscular exercise, including muscles, body temperature, 
respiratory, circulatory and metabolic changes; physical fitness; comparison of 
trained and untrained ; fatigue and staleness ; the measurement of fatigue and 
fitness; types of responses in rebreathing and color reactions on the rebreather. 
Practical material included work on the Henderson and Larsen Rebreathers, 
including set-up, calibration, preparation and operation in practice and official 
runs on both machines; gas analysis and the preparation of solution and set-up 
of apparatus; the Schneider Index; plotting and preparation of rebreathing 
records; rating; the low-pressure chamber with observations on the pulse, 
blood pressure and alveolar air; consideration of the English Test for flyers, and 
also the Dreyer Test and the Martin Test. 13 

After the war the name Cardio- Vascular Department was changed to 
aviation medicine and in 1922 was divided into two sections, roentgenology 
and photography, and cardiology. 14 The lectures and practical work cov- 
ered the following: cardiac pathology; sounds and murmurs, normal and 
abnormal; valvular defects, affections of heart muscle associated with retrograde 
changes, infiltration and subsequent repair; affections of the heart due to exoge- 
nous and endogenous influences; myocarditis in acute infection; anaphylactic 
heart; the arrhythmias; neuro-circulatory asthenia; general physical examina- 
tion and physical examination for flying; the rebreather and low-pressure 
chamber from a clinical standpoint; X-ray and fluoroscopy; the electrocardio- 
graph and the polygraph; the heart in aviation; and a series of clinics at the 
Bellevue Hospital, New York City. 15 The main change in this department 
was the increase in emphasis on clinical work. 

Instruction in aviation psychology was given by civilians from 1920 to 
1923, the department, head being a civilian, Miss Barbara V. Keyo. She was 
succeeded by Capt. Ida Peak (MC). From 1924 to 1926 added stress was 
placed on the discussion of reaction time equipment and the orientator. The 
lectures covered the following subjects: The standard psychological test; gen- 



150 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



eral psychological principles; psychological tests of efficiency; apparatus and 
wiring; emotion and its relation to efficient reaction; American and foreign 
psycho-physical tests; effects of alcohol and caffeine on efficiency; tests used 
by psychologists in A. E. F. ; and ratings. There was, in addition, practical work 
with the rebreather and the student acted as psychologist on as many official 
runs as possible. Practical work on apparatus and wiring, and on psycho- 
physical tests was stressed. 16 

Initially the Department of Neuro-Psychiatry was under the direction 
of Maj. R. F. Longacre (MC) who was succeeded in 1924 by Maj. Francis H. 
Poole (MC). The course covered the following topics: descriptive and genetic 
psychology; the nature, causes, general symptomatology and classification of 
mental disorders; dementia praecox; manic-depressive psychosis; paresis; 
the paranoias; psychoses associated with organic diseases and injury of the 
brain; symptomatic, infection-exhaustion, and toxic psychoses; presenile, senile, 
and arteriosclerotic psychoses; borderland and episodic states comprising 
constitutional psychopathic inferiority and the psychoneuroses; defective 
mental development; methods of examination; the neurological examination 
for flying; personality study; and a series of clinics at Bellevue Hospital 
and Brooklyn State Hospital. The studies in neurology comprised cerebral 
and segmental localization, conduction pathways and nerve distribution 
as developed by the intensive studies made of pupillary reactions, gait, reflexes, 
tics and tremors; and the significance of the normal and abnormal findings 
in the complete neurological examination. While more time was given to the 
clinical work, no significant changes were made in the content of the course 
of study during these years. 17 

In 1920 ophthalmology and otology were unified into one department under 
Maj. Lloyd E. Lefft (MC), who served as director until Capt. Charles H. 
Pfeffer (MC), relieved him in 1922 to serve as director until 1926. The instruc- 
tion in this department included: demonstrations and practical work on the 
examination for flying, including the set-up and use of apparatus; the importance 
of the eye in flying; anatomy of the eye and its external subjective and objective 
examination; brief consideration of the diseases of the eye and its appendages; 
disturbances of vision; general optical principles; refraction; retinoscopy; 
ophthalmoscopy; accommodation; convergence; extrinsic muscles; disturbances 
of motility and ocular manifestations of general disease. In the field of otology 
the lectures dealt with anatomy of the ear, nose and throat; pathology and 
treatment of ear, nose and throat conditions commonly met; the vestibular 
brain tracts and the associated centers and the orientor. Clinical work in this 
department was given at the New York Eye and Ear Infirmary. 18 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



151 



The Department of Administration existed for the sole purpose of instruc- 
tion, after 1922. Lectures and demonstrations were given on the various gas and 
liquid oxygen supply apparatuses; methods of testing the instruments; proper 
installation; advantages and disadvantages of the various instruments and ap- 
paratus comparison of the foreign and American flying examinations; aviation 
accidents; duties of the flight surgeon; paper work and practical work on the 
flying field ; work and records of branch and field units and the equipment for 
flight surgeons, rebreather and field units. 19 The time ordinarily allotted to the 
course was one day at the flying field and several lecture periods. By 1923 the 
study of protective devices in aviation and the organization of the Air Medical 
Service was securing increased attention. Later this department was absorbed 
by the Department of Aviation Medicine. 

Officers pursuing courses at the School were detailed in orders from the War 
Department upon the recommendation of The Surgeon General of the Army, 
at the instance of the Chief of Air Service. 20 Due to the small number of officers 
assigned, Major Bauer recommended in 1924: 21 

If it is not possible to detail a number of officers to the course and then assign them 
to the Air Service it is recommended that a certain number of the class graduating from the 
Army Medical School be detailed to take the course here in the Fall following their gradu- 
ation. These officers can then be returned to duty away from the Air Service. They will, 
however, be immensely benefited by having taken the course and will form a reserve in 
case of emergency. 

Standards were kept at a high level although according to Major Bauer 
only 14 men failed to complete the course during the period 1919 to 1925. Six 
of the failures were in 1919. Deficiency in preliminary professional ability and 
illness were listed as the main reasons for failures. 22 At the end of the course in 
1920 a general qualification oral examination was given by the staff, and the 
student was expected to attain a 75 percent average in all subjects and at least 75 
percent in his 5 major subjects. A rating of 90 percent was necessary for honors. 
In 1922 the requirements were raised to an 80 percent average and 75 percent 
in the lowest subject. By 1920 the student was also rated as to his aptitude for 
flight surgeon's work regardless of professional qualifications. All ratings were 
made by a faculty board, made up of the Commandant, assistant comman- 
dant, secretary and directors of the departments, 23 and matters concerning 
standings, ratings and efficiency of students were the concern of this academic 
or faculty board. 24 

Starting with the 1 February 1922 session the Naval Medical Corps 25 de- 
tailed officers to each class. It was felt that one school was amply equipped for 
the training of flight surgeons of both services. This opened up a field of 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



153 



cooperation between the services that was most desirable, and a good deal of 
friendly rivalry existed between the officers of the two services. From 1922 to 
December 1926, 34 naval officers graduated as flight surgeons. 26 

Foreign medical officers were permitted to take the course if they gained 
the permission of the Secretary of War and had a working knowledge of the 
English language. The first foreign students to complete the course were Lt. 
Mario Pontes de Miranda of the Brazilian Navy who graduated on 15 December 
1923 and Captain Armando de la Torre of the Cuban Army who graduated 
16 December 1927. 27 

The following chart shows the graduates in all courses offered by the School 
of Aviation Medicine from 1919 through 1926. 28 



Table 6. — The School of Aviation Medicine Graduates 



Year cal. 


609 
Examiner 


F/S 
Ass'ts. 


Flight surgeons 


Basic 
SAM 

18 
11 
15 
33 
21 
11 
24 
25 


Flight 
pract. 
SAM 


Surgeons 
pract. 
other 
fields 


Reg. 


Res. 


Guard 


Navy 


1919 




15 
15 


18 

11 
15 

17 

2 11 
6 
6 
6 












1920 














1921 














1922 1 










16 
9 






1923 


4 

7 
10 


5 
5 
3 
3 










1924 


3 
13 
12 


2 
2 






1925 


3 
8 






1926 


20 


1 











1 Fiscal year. 

2 1 Brazilian. 



An effort was made to keep in touch with the flight surgeon and his work 
after he graduated and this effort met with some success. The Commandant 
desired to go beyond the casual contacts and establish a systematic liaison plan. 29 

Major Bauer suggested in November 1925 that all medical officers at Air 
Service stations be flight surgeons and that the ratio of flight surgeon to cadets 
at Primary Training Schools be 1 to 35, and recommended that students selected 
to attend the School be below the rank of captain. He outlined a program of 
training that included 4 months at the School of Aviation Medicine; 6 
months practical work at Brooks Field; and a 4-year assignment to the Air 
Service. The successful officers were to be assigned to a general hospital for a 
year's intensive clinical work and then be redetailed to the Air Service for a 



154 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

period of 4 years. After this program had been completed the officers were to 
attend advance courses at Carlisle and the School of Aviation Medicine and be 
redetailed to Air Service. 30 

Courses for graduates were designed to meet the needs of graduate flight 
surgeons who desired to take further training in aviation medicine or one of 
the specialties allied to it. In 1921, for example, an officer took a 3-month 
course which consisted of clinical work at the Brooklyn State Hospital and 
a survey of the literature in the field, 31 while in 1922, a staff member took a 
course in psychoanalysis under Dr. A. A. Brill of New York and another naval 
officer took a special course in ophthalmology. Very few officers took advan- 
tage of this opportunity. 

In October 1923 an extension course to be conducted by the School of 
Aviation Medicine was approved by The Adjutant General 32 It was recog- 
nized that most of the Regular Army officers would be in administrative 
work and not available in time of war. It was also realized that the greater 
number of medical officers attached to the Air Service were those who would 
be expected to do the work of the flight surgeon. 33 The problem of training 
the Reserve and National Guard officers was a difficult one. It was a physical 
impossibility to get a sufficient number of men to spend 3 months taking 
instruction in a military school. The average doctor found it difficult to get 
away 2 or 3 weeks. It was difficult to get enough students for even a short 
course because of the lack of funds and the fact that officers of the National 
Guard and Reserve could not see the advantage of taking such a course in 
aviation medicine. It was finally decided to give didactic instruction by corre- 
spondence and a month to 6 weeks of clinical and practical work at the School. 34 

The plan for the training of medical Reserve officers and members of the 
National Guard fell into three sections: (1) the training of flight surgeon; 
(2) the training of 609 (later 64) examiners; and (3) the training of specialists. 
It was expected that the majority would be trained as flight surgeons. These 
officers would complete the correspondence work in the winter and the short 
basic course in the summer. 

The correspondence work was, at first, divided into 2 courses, each 
taking about 9 months, the whole course to last about 2 years. The first 
part was to consist of 24 lessons in ophthalmology and otology, 13 lessons in 
aviation medicine and 11 lessons in neuropsychiatry. It was to stress the 
theoretical side of the physical examination for flying so that the student could 
take the short basic course at the end of the first extension course. The second 
part was to consist of 4 subcourses, neuropsychiatry, aviation physiology, 



SCHOOL OF AVIATION MEDICINE AND RELATED PROCRAMS 



155 



aviation psychology and administration. This course was to stress altitude 
effects and the maintenance of the flyer. 35 In 1924 the correspondence course 
was given as a unit of 7 subcourses covering about 216 hours of work. The 
content of the course was about the same as the didactic work taught in the 
basic course at the School. During 1923-24 the enrollment of 10 officers was 
disappointing but by 1925-26 it had grown to 70 officers. The Commandant 
was not satisfied with this method of teaching or the results obtained, but con- 
sidering the need and the difficulties involved it seemed a desirable compromise. 80 

In order to qualify as a flight surgeon it was necessary to complete the 
correspondence course and the short basic course, or part of the correspondence 
course and 2 short courses, or 2 complete short courses. The short basic course, 
after the period of experimentation and trial, was 6 weeks in length and it con- 
sisted of the practical and clinical work of the regular basic course. 

On completion of the first year of the correspondence course and half the 
short course, or on completion of the entire short course, the student was re- 
ported as qualified to take the physical examination according to the Form 609, 
W. D., A. G. O. If the selected Reserve or National Guard officer took this 
work he was called a 609 (later 64) examiner. The officers in the first class, 
May 1923, took 3 and 4 weeks of training. No record is available concerning the 
2 officers who took the course for physical examiners in 1919 and 1920. During 
the period May 1923 to June 1927, 51 officers qualified as 609 examiners and 
22 of that number later qualified as flight surgeons. The question of ratings for 
these men came up again when the Air Surgeon decided in 1942 that if the 
records warranted, they could be qualified as aviation medical examiners. 38 

The third type of instruction for Reserve officers was the training of 
specialists, that is physiologists, psychologists, and ophthalmologists. As these 
men had proved their value in World War I, it was agreed that in case of another 
emergency they would be needed in experimental work or as instructors in the 
School. No evidence was found that this program was put into effect during 
the years preceding World War II. 39 

The Flight Surgeons' Assistants' Course originated in the program for 
training enlisted men during World War I. The course was designated to 
train qualified men as flight surgeons' assistants. An attempt was made to 
give the flight surgeon an assistant who had been well trained in helping to 
administer the physical examination and rebreather tests. The course for 
enlisted men was 2 months duration and included: Practical work on the 
Henderson and Larsen rebreathers, including the set-up, calibration, prepara- 
tion and operation of both machines; the taking of blood pressure and pulse; 
gas analysis and the preparation of rebreather records; the Schneider Index; 

262297°— 55 12 



156 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

the set-up of apparatus and the operation of the Barany Chair; the recording 
of the results of examinations and the paper work of a flight surgeon's office 
and rebreather units, and the care and set-up of equipment for flight surgeons, 
rebreather units and field units. 40 In 1923 more work in ophthalmology and 
in the set-up and working of psychological apparatus was added. 41 It was 
suggested that the post surgeon or flight surgeon give the enlisted men a 
written examination before sending in applications for training. Most of the 
difficulty resulted from the assignment of men who were unable to spell, write 
legibly, or work ordinary problems in arithmetic. 42 Thirty-one enlisted men 
were graduated from 1920 to 1926. 

When the School moved to Brooks Field, San Antonio, Texas, on 30 June 
1926, it was necessary to occupy the "Big Balloon Hangar" while plans were 
in progress for a new permanent building. 43 The plans for the new building 
were approved in early 1927, and ground was broken for the new building by 
4 March 1927. The structure, a two-storied hollow cement tile building, pro- 
vided for seven office rooms, a lecture room, library, physiology room, eye exam- 
ination room, store room and mechanical laboratory. The School moved into 
its first permanent building on 1 July 1927. 44 

In 1927 the Primary Flying School was to have three increments of 
students for flying training and it was decided to change the program of the 
School of Aviation Medicine to conform to this new situation. 45 The changes 
involved in no way affected the objectives of the School. As provided by 
AR 350-580, 30 December 1926, the School was to give instruction and training 
to officers in the organization and administration of the Medical Department 
as related to the special requirements of the Air Corps; the principles and 
technic of the physical examination of candidates for flying training and tests 
of flyers including the use of the special equipment required in conducting 
such examinations ; the application of tests of physical efficiency ; and the physi- 
cal care of flyers. It was also a part of the mission of the School to provide 
training and instruction for enlisted men in the subjects in which Medical 
Department technicians of the first, second, and third classes were required 
to be proficient with special reference to the development of qualified men 
for assignments as assistants to flight surgeons. The School was to conduct 
an extension course and could conduct a course for graduates. Investigation 
and research in aviation medicine was to be carried on as authorized by proper 
authority. 46 

The changes made in the program in September 1927 provided that three 
basic courses were to be conducted annually; each was to be of 3-months 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



157 



duration and the courses were to begin on 5 January, 1 May and 5 September, 
respectively. Each basic course was to be divided into two periods. The first 
period was to be of 2-months duration and was to be devoted to theoretical 
instruction; the last period was to be spent in practical work. 47 No officer was 
to be accepted as proficient to make the physical examination for flying until 
he had taken the practical instruction in the second period. Another important 
change made at this time specified that the short basic course was to be 
discontinued. 48 

The purpose of the basic course was to "instruct medical officers of the 
Regular Army, National Guard and Reserve Corps to perform efficiently the 
special duties of a flight surgeon, in peace or war, and to coordinate such 
duties with the other professional and nonprofessional activities which they 
may be called upon to perform as medical officers of the Army." 49 

In the interest of better organization, the Commandant submitted for 
approval on 16 February 1928 a draft of a proposed change in AR 350-580. 
Because of the acute shortage of personnel during 1926-1927, the Departments 
of Physiology and Administration were carried on by a single instructor, and 
the courses were of necessity brief. The Department of Cardiology was with- 
out a qualified instructor and a modified course covering the essentials was 
given by personnel at the Station Hospital, Ft. Sam Houston. 

The plan to reduce the number of departments of the School from seven 
to four, while at the same time retaining all the subjects, was incorporated 
into AR 350-580, 10 December 1928. The Department of Aviation Medicine 
was to include cardiology, physiology and administration. Another change 
divided the Department of Psychology into two sections, one for research and 
one for instruction. The Departments of Neuro-Psychiatry, and Ophthal- 
mology and Otology were not concerned in this reorganization. 50 By 1929 
the Commandant was able to state that "The functions of the School, particu- 
larly as it relates to the activities of flying training in the Air Corps Training 
Center have been well coordinated with the training program and the School 
feels that it has contributed in some measure at least to the constantly increasing 
percentage of graduates among those taking flying training." 51 

As a part of the Air Corps Training Center, the School was affected by any 
general change in the activities of the Center. This was true in 1927, and later. 
In response to a request for more adequate buildings at Brooks Field and Kelly 
Field, the Chief of the Air Corps visited the Training Center in December 
1926 and recommended "the establishment of the largest flying field in the 
world." 52 This request resulted in the construction of Randolph Field. 
Construction of the new School building at Randolph Field was begun in 



158 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



May 1 93 1. In order to provide time for revision of schedules and reorganiza- 
tion of instruction, the 5 August 1931 session was omitted. 53 The School of Avia- 
tion Medicine was moved to Randolph Field, Texas, on 30 October 1931, to what 
proved to be a more permanent home. All the advantages of Brooks Field 
plus the advantages of better accommodations for study and research, and 
room for expansion in case of emergency, were inherent in the new location. 54 

Soon after the arrival of the School at Randolph Field, the length of the 
course of instruction was increased from three to four months. 55 The first 
four-month class started on 1 January 1932, and the second on 5 May 1932. 
This change was embodied in the new AR 350-500, dated 1 October 1932. 
These new regulations governed the operations of the entire Air Corps 
Training Center and the School was specified in Section IV. The decrease in 
the number of courses from three to two per year and the increase in the length 
of the course were the only changes made that concerned the School. 56 This 
change was made because it was thought desirable to improve the instruction 
and training by application during the last half of the course. In order to 
accomplish this, the first two months were to be devoted exclusively to dual 
flying instruction and to theoretical and clinical instruction, and the last two 
months the instruction was to be both theoretical and practical, but with special 
attention devoted to the practical instruction in the physical examination of 
candidates for flying training and the care of flying personnel. 57 

The schedule was revised again when the dates for the periods of in- 
struction were changed to 1 January and 15 August 1933. Actually the August 
class in 1933 was cancelled due to the fact that the majority of the teaching staff 
were on temporary duty with the Civilian Conservation Corps within the VIII 
Corps Area. 58 Normal operation of the School was resumed on 1 January 1934, 
at the request of the Chief of Air Corps. 59 

Course dates were modified again in 1936, when courses were scheduled 
to begin on 15 July and 1 December. The schedule was shaped by three 
factors: the date of entrance of flying candidates to Primary Flying School; 
the dates best suited to assignment of Reserve and National Guard Officers; 
and the necessity for continuous instruction in the medical specialties. 60 

In 1939 the School program was criticized over the amount of practical work 
actually accomplished. 61 On 9 May 1939, a twenty-four-hour emergency course 
for flight surgeons covering all items of Form 64, except refraction, was prepared 
by the School at the request of the Chief of the Medical Division. This emer- 
gency plan as submitted was never put into practice either at Air Corps stations 
or at the School. 62 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



159 



The War Curriculum: SAM 

The wartime mission of the AAF in the Zone of Interior was that of train- 
ing. Thus, the Air Surgeon as senior staff medical officer was responsible for 
advising the Commanding General, AAF, on matters relating to advanced study 
in the field of aviation medicine and related training programs, as well as for 
supervising the day-to-day operations of medical installations under Air Force 
control. 

Prior to the outbreak of World War II, General H. H. Arnold, Chief 
of the Air Corps, recommended that the course of instruction for aviation 
medical examiner be shortened from four to three months effective with the 
current class. 63 In May 1940 he further recommended, "that effective 15 July 
1940, for a period of one year, the training program of the School of Aviation 
Medicine under the Protective Mobilization plan be put into effect," 64 which 
shortened the course from three months to six weeks. The reasons given by 
Arnold for this change in schedule were as follows: 65 

With the contemplated increase in the training program of the Air Corps, a great 
strain will be thrown on the available Flight Surgeons in the matter of examining and 
qualifying a sufficient number of trainees. It is estimated that a minimum of 50,000 
physical examinations will be made in addition to routine examination in order to obtain 
12,000 trainees within the next twelve months. 

In addition to the actual immediate need for qualified Flight Surgeons, the need for 
an adequate reserve of Flight Surgeons, in case of emergency, cannot be overstressed. 

It is proposed to begin immediately an extensive training program at the School of 
Aviation Medicine, Randolph Field, Texas, in order to qualify a sufficient number of 
Flight Surgeons for the immediate needs of the Air Corps and at the same time begin the 
training of an adequate reserve for use in case of a National emergency. It is estimated 
that under the plan as recommended below, approximately two hundred fifty Flight 
Surgeons can be qualified within the fiscal year 194 1, by shortening the course now given 
at the School of Aviation Medicine, Randolph Field, Texas, by increasing the size of the 
classes, and by detailing those Medical Reserve Officers who in the future will be ordered 
to extended active duty with the Air Corps, prior to reporting to their assigned stations. 

The basic course was now designed to train medical officers of the Army 
as aviation medical examiners. Most of the six-week period was devoted to 
theoretical and clinical instruction in the medical specialties; the rather leisurely 
pace of the days before the emergency was no longer possible. 66 The change in 
the number of hours of instruction per week indicates the increasing tempo. 
In the old four-month course, thirty hours of instruction a week were given; 
in the three-month course the instruction time was increased to forty-three 
hours a week; and in the emergency six- week program an instruction week of 
fifty hours was provided. 67 



160 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



While the shortened courses during the period i July 1940 to 1 July 1941 
provided a sufficient number of medical examiners — approximately 240 having 
been graduated from the basic course — it was the considered opinion of 
the faculty that 6 weeks was not sufficiently long to provide an adequate 
groundwork and practical application for the large classes. The experience of 
the trial period of one year showed that the aviation medical examiners were 
not as well trained as their predecessors, particularly in connection with the 
examination for the selection of flying cadets for training. This was supported 
by reports from various stations that the recent graduates did not compare 
favorably with other officers who had received a longer course of instruction. 68 

The Commandant, Lt. Col. Fabian Pratt (MC), therefore requested that 
the course be lengthened to 3 months. He also recommended that, as the tem- 
porary buildings at the School would be completed in June 194 1, 100 students 
be assigned to each class. 69 A course of 12 weeks' duration was approved 
and it was also decided to increase the number of the student officer courses 
from 3 classes to 4 classes. 70 

In November 1941 Maj. Harry G. Armstrong (MC), cited the experience 
of the Canadians and British to prove that examining teams in the reception 
centers soon became stale under the deadly monotony of being responsible for a 
certain phase of the examination for a long period. As a solution to this 
problem he proposed that student officers' training at the centers stress practical 
work. This performance would provide a concrete demonstration of his medi- 
cal-military ability in all fields so that he could be assigned to the duty for 
which he was best fitted. 71 In keeping with the recommendation, the new 
Commandant, Lt. Col. Eugen G. Reinartz (MC), wrote the Training and Re- 
placement Center surgeons for suggestions. Reactions to the proposal varied 
considerably. 72 

Two events provided an opportunity to act upon the Armstrong recom- 
mendation. There was an increase in the number of students entering the 
school; and the Commandant of the School recommended that with the crea- 
tion of the Aviation Cadet Classification Centers there also be established 
branch schools. In February 1942, it was directed that this plan be carried out. 

The 3-month course was divided into two periods of 6 weeks each. 
The first period was to cover didactic work and to be given at the School; the 
second period, covering the practical work, was to be given at the three cadet 
replacement centers located at Santa Ana, California; Kelly Field, Texas; and 
Maxwell Field, Alabama. This would not only double the output of the School 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



161 



but also provide for using one-half of the officers attending the course for 
examining work during their training period. 73 

On 6 April 1942 the first class to take the divided 3-month course began 
training at the School of Aviation Medicine. Instruction was continuous 
with a class graduating from the reception centers each 6 weeks, and a new 
class entering the School of Aviation Medicine each 6 weeks. A class left the 
School on Saturday and a new one arrived on Monday. 74 The didactic portion 
of the course as given at the School consisted of conferences, lectures, clinics, 
guest lecturers, demonstrations, quizzes and prescribed reading. During 1942, 
drill, physical exercise, a 3-day bivouac and a final parade review were added 
to the program. 

Due to the greatly increased demands for aviation medical examiners caused 
by the tremendous expansion of all the Air Forces personnel, the size of the 
classes at the School was constantly expanded. Classes originally averaging 
around 100 each, were in September 1942 increased to approximately 320 each. 

The completion of a temporary building, Schick Hall, with a classroom 
large enough to seat 165 students, failed to solve the classroom problem since 
it was inadequate for the large classes. 75 Lectures were repeated morning and 
afternoon. In the second portion of the program it was necessary to divide 
each of the 2 squadrons into 6 sections. 76 A recommendation of The In- 
spector General, Gulf Coast Air Corps Training Center, that the School be 
moved to some city where college facilities could be used, while accepted in 
principle, was not considered feasible by the Commandant, Colonel Reinartz. 
He pointed out that such facilities probably were not available and that even 
if they were, this would cause an interruption of training that would cripple the 
activities of the classification centers. The Commandant recommended instead 
that the School remain at Randolph Field and that a new classroom building 
be constructed. 77 

In January 1943 a large classroom building, Stafford Hall, located behind 
the Research Building, was completed. It contained a central lecture room 
which seated the entire class of 320 at one time, and four additional small rooms, 
used for section work. All students could now have their lecture conferences in 
the morning in a single group and have demonstrations and applicatory 
exercises in the section rooms in the afternoon. 78 

Since the chief function of the classification center was the examination 
and classification of cadets, the centers, therefore, were not ideally equipped 
to teach operational subjects whether of medical, administrative, or tactical 
procedure. It was generally agreed that the training at the branch schools 



162 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

stress selection and classification and that at least two-thirds of the medical 
officers trained there needed more training in maintenance of the flyer. 

A study of the 6-weeks Practical Training Course at the branch schools 
of aviation medicine revealed a lack of uniformity in schedule and a mis- 
directed training objective. It was believed that the primary objective of the 
course should be the preparation for combat service with tactical units in the 
combat zone. Training as medical examiners or hospital administrators was 
considered secondary. On 16 September 1942, therefore, the Air Surgeon 
directed that a committee meet at the headquarters of the Army Air Forces 
Training Center to recommend a uniform schedule and program for the 
practical work at the classification centers. 79 

The committee decided that the 6-week period should be divided into 
3 portions of 2 weeks each. During one 2-week period the student was 
to be assigned to do actual physical examinations on the examining line, and 
was to be rotated from station to station in that line so that he performed 
each part of the examination of hundreds of actual aircrew applicants. During 
the second such period he was to be assigned to the groups investigating the 
mental make-up of aviation cadets. The third period of 2 weeks was to be 
used by the student in studying the practical problems in connection with burns, 
ophthalmological injuries, fractures, dermatology, basic principles of plastic 
surgery, anesthesia in the field, identification of personnel involved in aircraft 
accidents, the operation of aid stations, defense against chemical warfare, Air 
Force medical supply problems, field sanitation and similar aspects of combat 
which could be taught in the hospitals connected with the centers. 80 It was also 
recommended to the committee that officers with combat experience be as- 
signed to the classification centers and that they act in close liaison with the 
School of Aviation Medicine. This program was designed to accomplish the 
maximum amount of training in the allotted 6 weeks' time, and was to be 
subject to change only by the Commandant of the School of Aviation Medicine 
or the Air Surgeon. The schedule was put into effect at the branch schools in 
November 1942. Subjects taught at the branch schools were to be deleted 
from the curriculum at Randolph Field. 81 But as late as April 1943, despite 
the master schedule, the courses at the branch schools were not uniform and 
in some cases there was duplication of material already taught at Randolph 
Field. 82 

The San Antonio Branch of the School of Aviation Medicine was located in 
the Classification Center of the San Antonio Aviation Cadet Center. In the be- 
ginning, the Cadet Center was a part of Kelly Field, Texas, but on 3 July 1942, 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



163 



it was activated as a separate post. The Cadet Center was divided into three sec- 
tions, namely: Preflight School (Pilot); Classification Center; and the 
Station Hospital. 83 

The first class of student officers arrived on 17 May 1942, but the published 
authorization for the branch school was paragraph 9, AR 350-500 dated 11 
August 1942, and AAF Regulation No. 50-17, 30 October 1942. The Medical 
Processing Unit in the Classification Center was begun on 4 November 1942. 84 

At the time the first class of student officers reported, the program was 
divided into two parts, half receiving training in hospital administration and 
half in the examining unit. A schedule was set up in the latter whereby each 
student officer progressed daily from station to station until he had participated 
in every phase of the examination for flying. At each station a staff officer 
instructed the student in the proper method of examining and then observed 
him while he performed the work. In addition each staff officer gave lectures 
on his professional speciality to the students. 

The course in hospital administration was designed to acquaint the officers 
with the duties and responsibilities of the commanding officer of a station hos- 
pital ; to give each officer instruction in the preparation and disposition of hospi- 
tal records and reports; to acquaint officers with the methods of procurement, 
storage, issue and safeguarding of medical supplies; and to familiarize each 
officer with the administrative procedures governing each department of the 
hospital. Officers were assigned in groups to the following departments : Com- 
manding Officer; the Registrar; the Hospital Mess, the Medical Supply Depart- 
ment; War Management; the Medical Inspector; the Chief Flight Surgeon, the 
Dispensary; Laboratory and Roentgenological Service; the Pharmacy; the Med- 
ical Department. The officers were rotated at frequent intervals according to 
a published weekly schedule. Instruction of the officers became the responsi- 
bility of the senior officer in each department who submitted a grade on each 
officer at the completion of the course. Instruction was conducted by brief, 
informal discussions of departmental administrative procedures followed by 
applicatory exercises. 

By 1 November 1942 the increase of medical officers from an average of 38 
to 107 for the first four classes, and the desire for a uniform schedule in all of 
the three branch schools, necessitated a change in schedule. As decided in the 
September conference at Headquarters, Army Air Forces Training Center, 
the class was divided into three groups, one assigned to the hospital, another to 
the Medical Processing Unit, and a third to the Flight Surgeon's Office. The 
group assigned to the Medical Processing Unit rotated from station to station, 
as before, and received their instruction on the examining line. At this time a 



164 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



routine ARMA study was started on all cadets being examined. This part of 
the examination had not previously been a part of the examination but was 
only done on selected cases. 85 The group assigned to the Flight Surgeon's 
Office performed individual examinations, each officer carrying the cadet 
through the complete examination including the ARMA. 

On 31 January 1943, when a second building, Medical Processing Unit No. 
2, was occupied, the examination of cadets was extended from one day to two 
full days. During the time the branch School of Aviation Medicine was located 
at the Classification Center, 103,719 examinations were accomplished, or an 
average of 8,643 P er class. 86 

During the period 18 May 1942 to 29 September 1943, a total of 1,020 med- 
ical officers were trained at the San Antonio Branch School. 87 

The decision of the Air Surgeon to discontinue the branch school as of 
7 October 1943, 88 was considered by the San Antonio Branch School as a severe 
blow in operating the Medical Processing Unit for at that time the branch 
school and the Medical Processing Unit were well integrated and operating 
efficiently. Due to the reorganization of the staff and the large amount of work 
accomplished it was felt that the students assigned to the branch school con- 
tributed materially to the successful operation of the Medical Processing Unit 
and that they gained valuable training from the work performed at the Classi- 
fication Center. 89 It was reported that the quality of the examinations dropped 
off during the first 2 months following the discontinuance of the school. 

The Flight Surgeon's Office of the Air Corps Replacement Training Center 
(aircrew) was activated on 28 February 1942. The post was renamed the Santa 
Ana Army Air Base on 30 April 1942, which in turn was renamed the Air Crew 
Physical Processing Unit. The Santa Ana branch of the School of Aviation 
Medicine was established on 22 May 1942. 

During the first 6 months of operation of this branch school, from 22 May 
1942 to 5 November 1942, the classes of the school were held on a monitorial 
system. The work was based almost entirely on the physical examination, with 
some work in administration in the flight surgeon's office. The students were 
divided into eight groups, and each group spent 4 days in each of the depart- 
ments of the examining line. 00 After November 1942 the standard schedule 
for branch schools was put into effect, and as at other branches, the work 
was divided into the three 2- week periods. 91 

During the period 22 May 1942 to 7 October 1943, a total of 77,561 physical 
examinations for aircrew training was made. The average number completed 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



165 



per student per day was 4.7. A total of 666 aviation medical examiners was 
trained during the period 22 May 1942 to 7 October 1943. 92 

On 21 May 1942 the Classification Center at the Southeastern Air Force 
Training Command, Maxwell Field, Montgomery, Alabama, initiated a project 
for the training of medical officers. 93 Although the objectives to gain experi- 
ence in administering the examinations for flying and to gain knowledge of the 
operation and administration of a station hospital were admirable, "the time was 
largely wasted . . . instruction was arranged haphazardly and the cooperation 
of many of the officers left much to be desired." 94 In July 1942 the Classification 
Center was moved to the Nashville Army Air Center, Nashville, Tennessee, and 
the post surgeon became commandant of the branch school. 

The work of the branch school was centered around the hospital, the Phys- 
ical Examining Unit and Psychological Examining Unit. As late as August 1942, 
the hospital was not in complete operation, and this handicapped the course in 
administration. The section of the class assigned to the hospital was divided 
into groups of 3 and spent 3 days each with the surgeon, executive officer, 
medical inspector, veterinarian, registrar, mess officer, and supply officer. 95 
In November 1942, the master schedule was put into effect and the 84 hours of 
work were taught in three 2-week sections. 96 In order to eliminate a repeti- 
tion of subject matter already taught at Randolph Field from the program, at 
the Nashville Branch School the schedule was revised in April 1943. Due to the 
shortage of medical personnel at the branch school it was necessary to use stu- 
dent officers approximately 2 hours each morning and evening in the care 
of cadets. Study of the schedule of the Nashville branch school brought out the 
need for correlation and elimination of duplication between the branch school 
and the present organization at Randolph Field. 97 Approximately 102,000 
physical examinations were completed during the period July 1942-October 
1943. 98 The size of the classes ranged from 15 in the first class, to 133 in the 
largest class. During the period 21 May 1942 to 7 October 1943, a total of 1,092 
student officers in 11 classes graduated from the Nashville Branch School. 09 

Meanwhile, in June 1943, General Reinartz recommended that a course of 
10 weeks be allotted to the School of Aviation Medicine and that the entire 
course be taught there. 100 In September 1943 he made a final inspection tour of 
the branch schools and in October 1943 the three branch schools were inactiv- 
ated by the Air Surgeon. No transfer of personnel, physical installations, 
equipment, supplies or funds was involved. Arrangements were made to pro- 
vide for the physical examination and classification of aviation cadets at the 
classification centers. The class of instruction at the School of Aviation Medi- 



166 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



cine commencing 12 July 1943 and completing its course of instruction on 7 
October 1943 was the last class to attend the three branch schools. 101 

On 7 October 1943 the Aviation Medical Examiners' Course was shortened 
from twelve weeks (six weeks at the School and six weeks at one of the three 
reception centers where branch schools had been conducted), to a nine- weeks 
course, all given at Randolph Field. This necessitated a change in the cur- 
riculum whereby all of the studies pursued at the branch schools were dove- 
tailed with those given at the School of Aviation Medicine, and at the same 
time condensed into one-half the time given to these subjects at the branch 
schools. It was possible to reduce the hours of instruction from fifty to forty-six 
hours per week and to allow a one-week interval between classes. 102 The new 
course produced marked improvement in the instruction of aviation medical 
examiners. 

It was the desire of the Air Surgeon that eventually all medical officers on 
duty with the Army Air Forces complete the Aviation Medical Examiners' 
Course at the School of Aviation Medicine and that all Medical Department 
officers who were likely to see service in the theaters of operations attend the 
Tactical Unit Surgeon's Course at the School of Applied Tactics, Orlando, 
Florida. To accomplish this in the most practicable manner and to prevent 
personnel from being away from their home stations for an undue length of 
time, the orders assigning an officer eligible for overseas duty to the School of 
Aviation Medicine also directed the officer to attend the Tactical Unit Surgeon's 
Course at the School of Applied Tactics. Subsequent to 7 July 1944 medical 
officers ordered to the School of Aviation Medicine received additional training 
at the AAF School of Applied Tactics, Orlando, Florida. 103 In avoiding unnec- 
essary duplications of training, the courses of instruction at the two schools were 
coordinated in April 1944. 104 The School of Aviation Medicine was directed to 
limit its activities to professional medical training while the School of Applied 
Tactics was to direct its efforts toward training in administration, military- 
medical and tactical subjects required to prepare officers for field duty. A critical 
survey of subject matter at the two schools was made, and curricula were modi- 
fied so that the portions of the course deleted from the curriculum of the School 
of Aviation Medicine were placed in that at the School of Applied Tactics. 105 
The inactivation of the Tactical Surgeon's Course at the School of Applied Tac- 
tics in October 1945 made it necessary for the School of Aviation Medicine to 
reassume responsibility for certain administrative and tactical instruction. 

Finally, mention must be made of the fact that in July 1944 it had been 
decided that flying training be reestablished in the curriculum of the School of 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



167 



Aviation Medicine. 106 Commencing with the 31 July 1944 class the course of 
instruction was increased from nine to eleven weeks. This was to provide suffi- 
cient time to incorporate flying training into the curricula; to permit expansion 
of professional medical subjects; and to provide each student medical officer with 
one afternoon each week for exercise and recreation. 107 Each eligible class mem- 
ber beginning on 31 July 1944 received ten hours of dual flying indoctrination. 
Student officers who desired this training were required to meet physical stand- 
ards (examination for flying), Class I or II but when defects were within limits 
prescribed for Class III they could be qualified in this class with a waiver. 
Student officers could not be older than thirty-five and one-half years, and were 
to be qualified psychologically for assignment to tactical units. 108 

Students used BT-13 airplanes and occupied the front seats. No solo 
time was given. A total of 164 medical officers completed the flying indoctri- 
nation. Thirteen dropped the course between 31 July 1944 to 23 May 
1945. 309 Out of a class of fifty-six men, including sixteen over thirty-six years of 
age, only one man did not desire flying training. 110 Officers taking this course 
gained a greater appreciation of the nervous tension and stresses involved 
and experienced them themselves. They also gained greater appreciation of 
the physiological aspects of flight. 111 

The ground school instruction was given to all students by Air Corps 
officers through the Department of Military Medicine. During the first class 
the nonflying members of the class had the time off but in subsequent classes 
they received link training instructions and lectures on Army Air Force traffic 
control systems, weather, radio procedures, radio range and other navigational 
aids to the pilot. 

Plans had been made in September 1945 to give two weeks of ground-school 
and dual-flying instruction at an adjacent primary flying field. 112 When the 
AAF Central Instructors School and the Primary and Basic Flying Training 
Schools were transferred to Randolph Field this became unnecessary. Instead 
of giving the ground-school and dual-flying training in the afternoons during 
the fourth and fifth weeks as in the past, the course was changed so that the 
first nine weeks were devoted to academic work and the last two weeks were 
reserved for ground-school instruction and dual-flying training. 113 

While eight departments furnished the bulk of the instruction to the stu- 
dent officers, many special lectures on such subjects as dental emergencies, 
pathology of aircraft accident, psychomotor classification tests, pharmacology, 
toxicology and therapeutics of penicillin, sulfonamides and other drugs, nutri- 
tional problems in the AAF, air evacuation procedures, AAF Physical Fitness 
Program, and the AAF Convalescent Training Program were given by other 



168 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



departments. 114 An open house was held at the research laboratory once during 
each class and a talk was given to the students concerning the research program. 116 

The wartime curriculum for flight surgeons and aviation medical exam- 
iners is discussed below in some detail. 

During 1941, while courses in physical diagnosis, cardiology, physiology, 
and administration were included in the program, the main emphasis was placed 
on selection as performed by the "64" examination. A considerable amount of 
time was devoted to the examination of the heart and circulation, and to the 
enumeration of the cardiovascular compensations to the various stresses of 
flying. While it was not intended to make heart specialists of the flight surgeons, 
a brief post-graduate course in cardiology was included in the course of instruc- 
tion. After Pearl Harbor, a shift in emphasis took place as a result of criticism 
that the School had stressed the physical examination too much and had spent 
too little time on preparation for field service with the Air Forces. 116 In 1942, 
however, the Commandant was able to write as follows : 117 

The course at the School of Aviation Medicine has materially changed since October, 
as we are stressing the practical aspects of field duty more and more and the physical exam- 
ination is only of material interest to those who are assigned to classification centers and 
replacement centers. To be sure 64 Examinations are made but they are few and far apart 
except at the centers mentioned. We have added tropical medicine, field sanitation and 
hygiene, first aid, shock treatment, low pressure chamber work and other features to our 
curriculum. Furthermore, some compulsory exercise and drill have been added. 

As a result of this change of emphasis, instruction in roentgenography and elec- 
trocardiography was reduced to a minimum. It was realized that specialized, 
heavy equipment would not be available at many new medical installations. 
With this in mind a series of detailed lectures on stethography, augmented by 
demonstrations, were added to the course. Even these lectures were later re- 
duced to the minimum. 118 

In a survey of December 1941, the most common criticism made by gradu- 
ates of the School pertained to their lack of knowledge of administrative pro- 
cedures. One surgeon wrote as follows: "These men have no conception of the 
correct way to render reports, make out requisitions, fill out vouchers, etc. 
Most of our trouble with new Flight Surgeons is along these lines, and not with 
Flight Surgeon duties in a narrow sense of the word." 119 In order to supply this 
information in the limited time available, the study of Air Corps subjects and 
of dual flying was omitted from the regular course of study. 

Since a large proportion of the medical officers who attended the School 
were assigned to Air Forces units without the benefit of instruction at the 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



169 



Medical Field Service School, Carlisle, Pennsylvania, it was decided to change 
the course of study so that they could better perform their duties as junior officers 
of the Medical Department. The material added to the course and approved 
on 29 December 1941, was in the fields of military training, military preventive 
medicine and of administration. 120 One result of this change was the addi- 
tion of a course in field medicine which included conferences on field sanita- 
tion; chemical warfare; emergency medical and surgical procedures; 
demonstrations of sanitary installations in the field; group and squadron air 
equipment; the use of splints and litters; and applicatory exercises in both gas 
warfare and in the use of the service pistol and machine gun. The course 
in field medicine was transferred to the Department of Military Medicine at 
the time of its creation in November 1942, and is discussed later in this chapter. 

Beginning 10 July 1942 lectures on plastic surgery were given by Capt. 
T. G. Blocker (MC) Kelly Field, and Col. Robert Ivy (MC). A month later 
upon the advice of the Air Surgeon, the training in plastic surgery was dropped 
from the curriculum of the didactic portion of the course and incorporated into 
the work at the classification centers since they had instructors capable of con- 
ducting the practical and theoretical portions of the course and the hospital 
facilities available to teach maxillofacial surgery. 121 

In line with the trend toward incorporating more field medicine in the 
course, a qualified surgeon was added to the staff of the Department of Medicine 
to give a course in the surgical problems encountered in the field and how they 
might best be handled. 122 It included the handling of casualties in combat; 
the removal of injured airmen from crashed aircraft; and also the treatment 
of thermal injuries. Wounds of the abdomen, crush syndrome, amputations, 
thoracic injuries, anesthesia, peripheral circulatory failure, craniospinal injuries, 
and fractures were also discussed. In addition, summaries were given on the 
type of pathology encountered in aircraft injuries as this material became 
available from investigations carried on in the pathology laboratory. 123 

Conferences were also devoted to the discussion of the response of the 
body to cold ; physiological effects of speed, velocity, linear, radial and angular 
acceleration; and to diarrheal control in Army installations. In 1943 addi- 
tional stress was placed on such clinical subjects as atypical pneumonia, in- 
fectious hepatitis, rheumatic fever and arthritis. In October 1944, due to the 
fact that dermatological disorders constituted a primary cause of morbidity in 
many theaters of operation, additional instruction was provided to demonstrate 
the more common cutaneous lesions. 24 



170 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

The Department thus came to fulfill a twofold role — that of training med- 
ical officers in aviation medicine and that of training medical officers to deal 
with medical problems apart from aviation medicine that would be encoun- 
tered in the field. The emphasis during the latter years of the war was grad- 
ually shifted to include more medical and clinical work. 125 In keeping with 
this trend, the Department of Aviation Medicine and Clinical Investigation was 
designated the Department of Medicine, 22 September 1944. 126 The Depart- 
ment had been responsible for the teaching of many and various subjects but 
on 9 April 1945 the Department of Physiology and the newly created Depart- 
ment of Surgery became responsible for the teaching in physiology and surgery. 
The Department of Medicine confined its instruction to the use of special diag- 
nostic and laboratory procedures in the physical examination for flying and a 
review of the medical entities likely to be encountered in military practice/ 27 
It was hoped that the School would eventually act in an advisory capacity to 
the various surgeons throughout the AAF in regard to proper disposition of 
certain medical problems among flying personnel. 

The teaching of tropical medicine at the AAF School of Aviation Medi- 
cine had its beginning on 6 April 1942, with the inclusion of 12 lectures 
on tropical diseases in the teaching program of the Department of Aviation 
Medicine. This addition to the schedule of the School was dictated by two 
considerations: the increasing importance of tropical medicine in overseas 
military operations and the previous lack of training in tropical medicine re- 
ceived by a majority of medical officers reporting to the School for instruction. 

In August 1942 the Department of Tropical Medicine was formed. It 
provided instruction in the characteristics of the tropical environment, the 
diagnosis, prevention, and treatment of tropical diseases of military importance, 
the recognition of important disease agents and vectors, and the diagnosis of 
tropical infections by blood and stool examination. Laboratory teaching was 
instituted on 5 October 1942, with microscopes borrowed from Our Lady of 
the Lake College in San Antonio. By March 1943, 25 Bausch and Lomb micro- 
scopes were acquired along with additional teaching equipment and material. 

On 26 August 1943, when the Aviation Medical Examiners' Course at Ran- 
dolph Field was lengthened to 9 weeks, tropical medicine was given 32 lecture 
periods and io l / 2 hours of laboratory time. Now it was possible to cover the 
subject more adequately, and although the time allotted for laboratory work 
was not sufficient to provide adequate training in protozoology, entomology 
and helminthology, and the basic sciences of tropical medicine, sufficient oppor- 
tunity was available for training each medical officer in such fundamentals 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



171 



as the recognition of malarial organisms in thick blood smears. By this time 
medical officers were returning from overseas theaters and student seminars 
were emphasized. 

Individual sets of blood slides for microscopic diagnosis were now avail- 
able for laboratory use and benefited laboratory teaching. Several gross speci- 
mens of autopsy materials from cases of amebiasis, typhoid fever, and bacillary 
dysentery were obtained on loan and the case histories of these cases and the 
gross specimens used in teaching. An insectory for the rearing of mosquitoes 
was established and the various phases of the life cycle of the mosquito as well 
as the differential characteristics of the Anopheleni and Gulicina Tribes 
demonstrated to the class with these live specimens. 128 

On 31 July 1944, when the Aviation Medical Examiner's Course was 
lengthened to 11 weeks, more time was allotted to the instruction in 
tropical medicine. Laboratory time now permitted training in the microscopic 
diagnosis of intestinal infections by stool examination. Medical officers were 
taught the zinc sulfate concentration method, regarded as the best for routine 
laboratory work in facilitating the recognition of intestinal protozoa and 
helminths. 

After V-J Day, with the inactivation of the School for medical officers 
at the AAF Tactical Center, Orlando, Florida, and the acquisition of the files 
of the Arctic, Desert and Tropic Information Center, the activities of the 
Department of Tropical Medicine acquired wider scope. Methods of disease 
control previously taught at Orlando now had to be covered in the teaching 
given by the Department of Tropical Medicine, which also assumed a new 
role as a center for the collection and dissemination of information regarding 
health and sickness in warm climates. 

Prior to World War II, from 5 to 8 hours of the flight surgeons' cur- 
riculum were devoted to the teaching of surgical subjects. The subject 
matter varied slightly during these years and was concerned chiefly with 
fractures, craniospinal injuries and analysis of aviation accidents. From 1938 
to 1940, only 5 hours were offered in surgical subjects and 2 of these con- 
sisted of discussion of the problems of hernia and pes planus (flat foot). Inas- 
much as planes were relatively slow and carried few personnel and high altitude 
flight was not common, injuries due to abrupt deceleration and extremes of tem- 
perature (frostbite and burns) received little attention. By 1941 war prepara- 
tions were demanding that large numbers of medical officers be trained rapidly 
to perform field duties with tactical Air Corps units. As a consequence, the 
course was reduced to 12 weeks and only 2 hours could be considered to 

262297°— 55 13 



172 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



be in the field of surgery, despite the fact that foreign duty and combat service 
were imminent for many of the students. One hour dealt with crash equip- 
ment and another was devoted to discussion of surgical defects found on exam- 
ination of candidates for flying training. In 1942 the course was still further 
concentrated into 6 weeks. During this short course, 4 hours were utilized 
in discussing the management of shock, burns, fractures and the sulfonamide 
compounds. Progressively larger numbers of aviation medical examiner students 
had not attended the Medical Field Service School and the course at the School 
of Aviation Medicine represented their initial formal military training. 129 

Prior to late 1942 instruction in surgery was given by officers primarily 
interested in internal medicine or aviation medicine. In September 1942 a 
medical officer, qualified in the specialty of general surgery, was added to the 
staff. A subcourse — Military Surgery, Department of Aviation Medicine — was 
instituted and 7 hours were allotted to instruction in surgery. The additional 
subjects discussed were: emergency treatment at advanced stations, wounds 
of the chest and abdomen, and anesthesia. In 1943 a surgeon with combat 
squadron experience was assigned to the staff. He was permitted to expand 
the course in military surgery to include 13 hours of conference and 3 hours 
of demonstration. Added subject matter included: demonstration of path- 
ology found in victims of fatal aircraft accidents; discussion of blood substi- 
tutes and plasma fractions; discussion of the removal of the injured from 
wrecked aircraft; 130 the consideration of injuries due to blast and missiles; and 
demonstration of the evacuation of combat casualties. 

Increasing recognition of the importance of surgical training to the flight 
surgeon was reflected in the formation of a Department of Surgery in January 
1945. This action occurred simultaneously with the transfer of the station hos- 
pital to the School of Aviation Medicine. Additional medical officers qualified 
in surgical specialties were thereby made available as teachers. The time allotted 
to instruction in surgery was increased to 25 hours. Lectures were given in 
the treatment of abdominal injuries, genito-urinary injuries, craniocerebral 
injuries and 2 hours were devoted to the consideration of anesthesia in the 
field and resuscitation procedures. A conference in dental problems in the 
AAF was added. 131 

Following V-J Day the objective in teaching of surgical subjects was 
markedly changed. A progressively greater number of ASTP students (recent 
graduates of medical schools) were enrolled. Since these medical officers were 
for the most part not acquainted with basic medical problems of the Air Forces 
and because most of them had recently graduated from the Army Field Service 
School, it was seen that some modification of the course was necessary. Early 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



173 



in 1946 the lectures on the genito-urinary system, abdominal injuries, thoracic 
injuries, wounds of the extremities and anesthesia, were dropped from the course. 
An additional hour on frost-bite previously given by the Department of Medi- 
cine and a 3-hour demonstration in crash procedure and airplane fire fighting 
were added. 132 



Table 7. — Instruction Surgical Subjects, AAFSAM 1936-1946 



Year 


Department and 
course name 


Length of AME 
or F/S course 


Hours 
surgery 


Subject matter 


1936-37. . . - 


Aviation 

f* n 1 c 1 n 
1VX C U 1 L 1 11 c 

(Adminis- 
tration and 
Misc. Sub- 

JCC Us J. 


16 weeks 


8 


Analysis of aviation accidents. 
Use of the ambulance and crash 
tools. 

Injuries of the extremities. 
Splinting of the extremities. 
Head injuries. 
; Spinal injuries. 


193&-39. . . . 


Aviation 
Medicine 
(Adminis- 
tration). 


16 weeks 


5 


Aviation accidents. 

Spinal injuries. 

Injuries of the extremities. 


1939-40.... 


Aviation 
Medicine 
(Adminis- 
tration). 




5 


Pes planus. 
Hernia. 

Aviation accidents. 
Crash tools and their use. 


1941 


Aviation 




2 


Crash equipment. 

Regulations concerning surgical 




Medicine 








(Adminis- 






conditions. 




tration). 








1942 


Aviation 


6 weeks 


4 


Peripheral circulatory failure. 
Burns. 




Medicine 








(Field Med- 






Fractures. 




icine). 






Sulfonamides and their uses. 


1943 (early) 


Aviation 


6 weeks at 


7 


Battalion aid station emergen- 




Medicine 


AAFSAM 




cies. 




(Military 


(Didactic). 




Wounds of the abdomen and 




Surgery). 






chest 

Peripheral circulatory failure. 

Craniospinal injuries. 

Fractures. 

Burns. 

Anesthesia. 



174 MEDICAL SUPPORT 

Table 7. — Instruction 



OF THE ARMY 

Surgical Subjects. 



AIR FORCES IN WORLD WAR II 

AAFSAM 1936-1946— Continued 



Year 



Department and 
course name 



Aug. 1943- 
June 1944 



Jul. 1944- 
Apr. 1945 



Apr. 1945- 
Sep. 1945 



Sep. 1945. 



Dec. 1945- 
May 



Aviation 
Medicine 
(Military 
Surgery). 



Aviation 
Medicine 
(Military 
Surgery). 

Surgery 



Surgery . 



Surgery . 



Length of AME 
or F/S course 



Hours 
surgery 



9 weeks . 



11 weeks. 



11 weeks. 



11 weeks. 



9 weeks at 
AAFSAM. 



16 



19% 



21 



25 



25 



Subject matter 



Treatment at advanced stations. 
Shock. 

Wound healing. 

Evacuation of casualties. 

Head injuries. 

Abdominal injuries. 

Wounds of the extremities. 

Pathology found in aircraft ac- 
cident victims. 

Burns. 

Anesthesia. 

Blood substitutes. 

Added time pertained to treat- 
ment of aircrew casualties and 
pathology found in aircraft 
accident victims. 

Additional hours were devoted 
to the discussion of blood 
fractions, a 3-hour air evac- 
uation demonstration and a 
longer discussion of anes- 
thesia. 

Additions were 2% hours, Den- 
tal Surgery; 1 hour, Urology; 
and 1 hour, Blast and Missile 
Injuries. 

Emergency treatment at ad- 
vanced medical stations. 

Physiology and classification of 
shock. 

Blood substitutes. 

Blood fractions. 

Craniospinal emergencies. 

*Urological injuries. 

Traumatic wounds of the chest. 

War wounds of the abdomen. 

Emergency management of in- 
juries of the extremities. 

Injuries due to blast and missiles. 

Burns in the AAF. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 175 

Table 7. — Instruction Surgical Subjects, AAFSAM 1936-1946 — Continued 



Year 


Department and 
course name 


Length of AME 
or F/S course 


Hours 
surgery 


Subject matter 


Dec. 1945- 




9 weeks at 


25 


Removal of injured from 


May 


AAFSAM. 




wrecked aircraft. 








Anesthesia in the field. 










Resuscitation procedure. 










Background of air evacuation. 










The place of air evacuation in 










the medical service. 










Regulations pertaining to 










surgical conditions. 










Air evacuation demonstrations. 










Training films. 










♦Dropped in Feb. 1946. 


May 1946 


Surgery 


9 weeks at 


25% 


Introduction to surgical prob- 






AAFSAM. 




lems in aviation medicine. 










Crash procedure. 










Head injuries. 










Frost bite. 










Burns. 










Shock. 










Blood and blood substitution. 










Blast injuries and wound ballis- 










tics. 










Pathology of crash injuries. 










Dental problems in the AAF. 










Air evacuation. 










Seminars and examinations. 



♦Programs, AME, AAFSAM, 1936-1946. 

During the period 1941-1944 the didactic portion of the Physiology Course 
was expanded to include discussions of the physics of the atmosphere; noxious 
gases in aircraft; decompression sickness; respiration and circulatory responses 
to internal requirements and external environment; control of respiration; gas 
transport by the circulatory system; types and symptoms of anoxia and collapse 
at altitude. 133 

The instruction in physiology was primarily didactic until the completion 
of the low-pressure chamber in December 1941. Six hours of practical work with 
oxygen equipment, mask fittings and oxygen installations were added to the 
course. The use, limitations and proper installation of oxygen equipment were 



176 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



emphasized. A complete set of defective oxygen equipment was produced and 
used as a training aid. In 1944 a B-17 fuselage, completely fitted with oxygen 
equipment, was utilized in the instruction of medical officers in the use of oxygen 
equipment and resuscitation of anoxic personnel. Student officers were kept 
abreast of advances in connection with pressurized cabins and suits, heated 
flying clothing and other devices to increase the tolerance of the flyer to cold, 
anoxic high-altitude flying. 

The student officer was subjected to a "flight" in the low-pressure chamber 
at a simulated altitude of 35,000 feet for 3 hours in order that he might 
obtain first-hand information of the physical and psychological effects of such 
altitudes. 134 Emphasis was placed upon the study of indoctrination procedures 
in relation to the use and need for oxygen at altitude. The low-pressure cham- 
ber flight was a prerequisite to graduation from the course unless the student 
officer was excused for good and sufficient reason. 135 By March 1944 the cold 
chamber was available and an indoctrination flight at — 40 0 F. was conducted. 
This gave the student officer an opportunity to try available winter equipment. 133 

Since it was obvious that most of the graduates of the School would 
at sometime have to live in field installations, it was decided to add a 
course in "Field Medicine." The new Department of Military Medicine, 
created in November 1942, was responsible for instruction in the organization 
and functions of the Air Forces; the problems of sanitation and hygiene in 
the field; chemical warfare; equipment in the field; principles of supply and 
administration; practical aspects of flying; evacuation of the wounded by air; 
field exercises; and war medicine. By October 1943 a 6-day bivouac was 
given to each class at the Leon Springs Military Reservation, Leon Springs, 
Texas. These field exercises were expanded to provide a study and practical 
application of military medicine in the field, mess sanitation, chemical warfare, 
use of the flight service chest, defense against air and mechanized attacks, or- 
ganization of the squadron aid station, mosquito control, and water supply 
in the field. 137 The student officers did all the work in the camp, acted as kitchen 
police, assisted in cooking, set up tents, and built sanitary installations. While 
3 hours of didactic instruction per day were given to the student officers on 
bivouac, conditions were not conducive to learning, and the time so spent was 
not successful from a teaching standpoint. 138 

By early 1944 many officers who attended the School had overseas experi- 
ence. Furthermore, those coming from the continental United States had 
undergone a longer period of training in the Army Air Forces. Therefore the 
bivouacs were deleted from the course. The last field exercises were held 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



177 



during February 1944. While the bivouacs were a serious drain on the faculty 
they were also a definite morale builder and permitted the faculty to come 
into closer contact with the students. 

When the course of study was lengthened to 9 weeks much of the ma- 
terial taught at the branch schools was incorporated into the course in military 
medicine. The course length was increased from 121 to 214 hours. The addi- 
tional time allotted was used to increase the instruction in venereal disease, 
organization of the Army Air Forces, camouflage, preventive medicine, public 
health, military medical law, and foreign duty in the Middle East and South- 
west Pacific. The training in the practical aspects of flying was doubled, and 
instruction related to sanitary installations, chemical warfare, administration, 
and special equipment was increased. 139 

The time devoted to the study of military medicine was decreased from 215 
hours as of March 1944, to 44 hours in May 1944. The professional aspects 
of certain military subjects and preventive medicine were stressed ; for instance 
instruction in chemical warfare dealt with such medical aspects of the subject 
as the physiological effects of the various chemical agents, and the therapy to be 
employed. Because of the critical positions which might be held by graduates 
of the School, two lectures on the subject of foreign quarantine were included in 
the curriculum. 140 In April 1944 dietary problems of the various army rations, 
and nutritional requirements as related to the Army Air Forces were added to 
the course. 141 These lectures were later supplemented by color slides of some 
pathological lesions associated with deficiencies of certain vitamins and a prac- 
tical demonstration of emergency rations. 142 Instruction still stressed the con- 
trol of communicable disease, industrial preventive medicine as applied to the 
Army Air Forces, and preventive medicine in foreign theaters. 

In 1941 instruction in ophthalmology included: the proper technique of 
the eye examination; visual pathways; perimetry; use of the tangent screen; 
plotting of the red lens test; the field of binocular vision; the field of binocular 
fixation; heterophoria; concomitant and paralytic squint; optical effects of 
lenses; lens neutralization; retinoscopy; ophthalmoscopy; tonometry; the use 
of the large and hand slit lamp; the use of the binocular loupe; the method of 
instillation of mydriatics and myotics; the removal of corneal foreign bodies; 
color-vision testing; the use of the spectacle fitting set; and the properties of 
antiglare glasses. 143 When the course was changed ia April 1942, it was necessary 
to concentrate the material presented and the teaching of refraction was reduced 
to the presentation of the theory of refraction and optics with a minimum of 
practical work sufficient to make the student reasonably proficient. Expanding 



178 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

facilities included a fully equipped, 7-lane darkroom which thus provided 13 
eye lanes. Additional space was also provided for eye seminar work, and for 
the presentation of night vision and dark adaptation. 

Due to the war development, new subjects were added to the didactic 
portion of the course such as the treatment of burns of the eyes and eyelids; 
treatment of gas injuries to the eyes; immediate treatment of trauma of the 
face, eye and eyelids; and night vision and dark adaptation. 144 Aviation medi- 
cal examiners on duty in the field with the combat forces needed practical 
training in the treatment of these injuries and conditions and it was necessary 
for the School to modify its program to train them to care properly for the 
men in their charge. 

With the inauguration of the 9-week course the ophthalmic instruction 
was slightly increased; when the curtailment of instruction in military medicine 
in May 1944 increased the time allotment to ophthalmology, the department 
was reorganized. 145 Practical work and seminars were emphasized with a 
complete presentation and discussion of color-vision tests, tests for malingering, 
night vision and dark adaptation tests, ocular injuries and various aspects of 
the examination for flying. Elaboration of the care of external and internal 
diseases of the eye were additions to the course. Colored photographic re- 
productions of external and internal diseases of the eyes were prepared and 
placed on permanent exhibit for instructionl purposes. A motor-driven 
ophthalmotrope was developed at the School for teaching normal muscle bal- 
ance and muscle imbalance, as well as the anatomy and physiology of the 
extra-ocular muscles. 146 

Prior to January 1942 relatively little emphasis was given the subject of 
otorhinolaryngology in the course of instruction in aviation medicine. This 
was due to the fact that lectures in both ophthalmology and otorhinolaryngology 
were combined in the same schedule, ophthalmology being of primary interest 
to the personnel then assigned to the department. This attitude was reflected 
in the condition of the equipment available for teaching, which was meager, 
obsolete and inadequate. Proper examining facilities were found wanting in 
both space and arrangement. The published program outlined an instruction 
course designed to teach the proper technique of the ear, nose and throat 
examination; the anatomy of the ear, nose and sinuses; transillumination of 
the sinuses; hearing tests with the audiometer and tuning forks; the value of 
the Barany Chair and Caloric Vestibular Tests; and the changes produced by 
varying barometric pressure in the ear and sinuses. 147 Unfortunately, however, 
these subjects were not given their proper place in the curriculum. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



179 



Following Pearl Harbor, the necessity for expansion and reorganization 
became evident. The ear, nose and throat examining facilities were immedi- 
ately improved through the purchase of new equipment, and the renovation 
of rooms provided for this purpose. War developments caused changes to 
be made in the course in order to emphasize the importance of anatomy in 
relation to maxillo-facial injuries. The presentation of the physiology of hear- 
ing was reorganized to stress the effect of noise in communication and the 
traumatic effects on the organ of hearing. The physiology of the vestibular 
apparatus was condensed and simplified with emphasis on air sickness, vestib- 
ular illusions, and instrument flying. Lectures on the diseases of the nose 
and throat were expanded to present the causes and effects of lesions commonly 
encountered in the various theaters of operation. With the advent of faster 
climbing and faster diving aircraft the problem of aero-otitis media and aero- 
sinusitis required that more time be spent on the recognition, prevention and 
treatment of these ailments. 148 

A separate Department of Otorhinolaryngology was established on i Jan- 
uary 1944, because of the increasing importance of ear, nose, and throat disease 
throughout the Army Air Forces and because of the tremendous increase in 
the morbidity due to involvement of these organs. The statistical reports issued 
by the Air Surgeon indicating the high morbidity caused by upper respiratory 
infections, and the incidence of sinusitis, aero-sinusitis and aero-otitis in the 
United Kingdom and other theaters of combat, were brought to the attention 
of the department. As a result the course of study was revised continually in 
order to keep abreast of new developments and changes as they were reported 
from the various theaters of war. 149 

The treatment of nose and throat conditions required a knowledge of 
anatomy and physiology which medical officers as a group did not possess. 
Thus a very large amount of material had to be presented in a very short time. 
A partial remedy was to increase the course from 17 hours in October 1943 
to 36 in June 1944. The subjects taught remained essentially the same but 
improvement in organization and presentation kept pace with the expansion. 150 

As in other areas, the instruction was pragmatic in approach. Practical ap- 
plication of diagnostic and therapeutic procedures were demonstrated con- 
comitantly with discussion of the anatomy of the head and neck. This was 
the most effective means of securing attention. The physiology of hearing and 
of the vestibular apparatus was demonstrated respectively with electronic and 
communication equipment and by using models of the semicircular canals with 
the rotating chair. A thorough study of the diseases and injuries of the ear, 
nose, and throat emphasized the recognition and diagnosis of the more common 



180 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



afflictions. Discussions and demonstrations of specific problems of aviation 
otology such as aerial equilibrium and orientation, deafness resulting from 
noise and detonation, aero-otitis media and aero-sinusitis, communications, 
ear protectors and external ear infections were effective. As more time was 
allotted to the applicatory exercises the students acquired practice in the use of 
instruments and in the application of diagnostic and therapeutic procedures 
to each other. In 1944 instruction in the effect of radium on lymphoid tissue 
in the nasopharynx was added to the course. 151 

An effort was made to rotate teaching assignments to avoid monotonous 
repetition for the instructor and to provide him with the experience of coping 
with the problems associated with each subject given. This method provoked 
constructive criticism and cooperation among members of the staff and insured 
constant improvement in the material presented to the class. 152 

No adequate textbook or compilation on aviation otolaryngology was 
available at the School or in civilian literature, nor was there an existing War 
Department publication comprehensively covering this subject. To remedy 
this deficiency, a manual on otolaryngology in aviation medicine was written 
and used as the authorized reference for the subject. The apparent need 
for such a publication was indicated by the number of requests received by Air 
Force installations. 153 

The existence of two departments, Psychology and Neuropsychiatry, 
teaching somewhat similar subject matter, was based upon the assumption that 
psychology deals with the normal person and that neuropsychiatry deals with 
the abnormal person. 154 The course in psychology was in reality an introduc- 
tion to neuropsychiatry, and the instruction covered the general principles of 
psychology, personality study, and psychological research. 155 

Before Pearl Harbor, the primary aim of instruction was to prepare medical 
officers to perform the "Physical Examination for Flying." Since it was assumed 
that most applicants for flying training were within the limits of "normal," the 
main burden of teaching selection techniques fell upon the Psychology Depart- 
ment. The approach which was made to the problem of selection was in terms 
of choosing candidates who could "learn to fly." 156 The technique employed in 
eliciting disqualifying features was a form of biographical personality inven- 
tory. This careful, exhaustive neuropsychiatric examination was called the 
Adaptability Rating for Military Aeronautics. 

During the war no such time-consuming tests could be giv^n; instead the 
applicant took a psychological "screening test" when he first enlisted. If he 
passed, he was given a battery of "paper and pencil" tests including tests for 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



181 



practical judgment, arithmetic reasoning, vocabulary, mechanical comprehen- 
sion, reading comprehension, and knowledge of current affairs. To these were 
added a battery of psychomotor tests, for purposes of classifying applicants into 
pilots, bombardiers and navigators. The failure of these tests as a functioning 
whole made it necessary in the fall of 1942 to reinstate the neuropsychiatry ex- 
amination, although the time allotted was sometimes only a matter of minutes. 
But these changes in the examination made it necessary to alter psychological 
instruction in the School. 157 

By 1943 the emphasis began to swing from pure selection to a combina- 
tion of selection and maintenance. Some attention was given to maintenance 
in the psychological sphere, and to problems of operational fatigue, the rela- 
tion of anoxia to fatigue, and the psychology of combat operations. 158 The 
schedule provided for the teaching of methods for detecting early psychological 
inefficiency in flying personnel and the psychological aspects of fatigue and 
motion sickness. 159 A program was inaugurated in which student officers per- 
formed personality studies under supervision. 

In late 1942, meanwhile, the Department of Neuropsychiatry was given 
nominal control over the Department of Psychology which still preserved its 
autonomy administratively. Superfluous material was eliminated and in its 
stead was placed material designed to fit into a logical, organized presentation 
of the dynamics of behavior. Due to the unnecessary repetition of material, the 
Training Section, Department of Psychology, was absorbed by the Department 
of Neuropsychiatry in January 1944, as indicated below. 

Since it was not primarily concerned in selection and since it dealt with 
the "abnormal," the Neuropsychiatry Department, prior to Pearl Harbor, 
confined itself chiefly to classification of the major psychoses. Little emphasis 
was placed upon the neuroses and little time was given to the study of their 
prevention and treatment. "The embryo Flight Surgeon was taught that his 
chief responsibility in the field of neuropsychiatry was to detect behavior dis- 
turbances and to ground the patient. . . . Failure to continue flying, once the 
men had learned, was universally ascribed by Flight Surgeons to a highly, 
and wholly, conscious 'fear of Flying'." 160 Neither department recognized or 
presented the various "fatigue" syndromes as being primarily emotional 
problems. 161 Although considerable overlapping existed between the work 
of the Psychology and Neuropsychiatry Departments it was noted that "there 
was little true coordination of the two." 

A total of 21 hours was available for clinical instruction at the San Antonio 
State Hospital and Brooke General Hospital. The teaching objectives were: 
to provide instruction in the dynamics of behavior; to familiarize the student 



182 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



with the cause and meaning of psychopathology ; to shift attention from the 
major psychoses to the neuroses; to call attention to the emotional significance 
of various forms of "fatigue" and "aeroneurosis' , ; to prepare the flight surgeon 
to render psychotherapy at the first-aid level; to indoctrinate the flight surgeon 
in the methods of prophylaxis of emotional breakdown; to make the flight 
surgeon conscious of the importance and significance of so-called psychosomatic 
conditions; and to de-emphasize the role the physician might be expected to 
play in determining actual aptitude for flying. 162 

In 1943 the time made available for lectures was increased to 35 hours 
per class. As the time was increased, most of the major objectives were 
attained. The fundamental psychological principles of both normal and 
abnormal mental functions were presented and the concept that psychic and 
somatic factors of the personality react as an integrated unit was emphasized. 168 
Particular emphasis was placed on the presentation of the mental mechanisms 
and the fact that differentiation between the normal and abnormal was largely 
quantitative. The psychological concept of mental disturbance was presented 
in order that students might have at least a working knowledge of the funda- 
mental psychopathology concerned before beginning clinical studies. This 
was especially important in view of the fact that a majority of the students had 
very little previous training in this field of medicine. Even younger graduates 
of medical schools were found to be inadequately trained in this respect. 164 

An effort was made to limit the subject matter to those things which 
would find practical application under actual combat conditions. It was 
recognized that the hazards involved in aviation and in a general environment 
of war were ideal for the development of mental diseases and for the activities 
of latent psychotic tendencies. The problem of maintenance had become as 
important as that of proper selection of flyers. Much of the clinical study 
was devoted to psychoneurosis and the so-called war neuroses. Very little 
time was spent on schizophrenia and the manic-depressive psychoses. 
Consideration of all other major psychoses was discontinued. 165 

Detailed instruction was given in the medical and administrative handling 
of neuropsychiatric cases in the theaters of operations and in the Zone of Interior. 
All available reports from the Allied Air Forces were freely drawn upon in 
the study of psychoneurosis and war neurosis cases. As reports were received 
concerning the increasing importance of the constitutional psychopathic state 
to the military physician this subject was presented in more detail. 166 

Clinics were originally held at both the San Antonio State Hospital and the 
Brooke General Hospital, Fort Sam Houston, but in 1943 the clinics at the 
San Antonio State Hospital were discontinued because of transportation dif- 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



183 



Acuities. 167 In January 1945 the School of Aviation Medicine, by assuming 
control of the station hospital at Randolph Field, obtained a potential source 
of clinical material for teaching purposes. By middle 1945 this source had 
been thoroughly exploited and proved adequate to meet the existing needs. 
The end of hostilities, however, brought a rapid decrease in this type of patient 
at this hospital. 168 

On 1 January 1944, due to the consolidation of various departments within 
the School, both the teaching department formerly designated as Psychology, 
and the Neurology and Psychiatry Laboratories were merged with the Depart- 
ment of Neuropsychiatry. Because of the increased teaching involved, addi- 
tional hours were made available to the department. It was then possible to 
teach more material because the course in psychology was incorporated into 
the course in neuropsychiatry in a logical sequence of lectures and conferences 
with the deletion of some overlapping and duplicating features. 169 By this 
time the course offered had embraced head injuries, peripheral nerve injuries, 
and some orientation in electroencephalography as well as the material pre- 
viously noted. 

During 1944 several changes in the official policies concerning terminology, 
treatment and disposition of cases of disturbances of behavior were incorporated 
into the instruction of medical officers. The neuropsychiatric problems of the 
returnee assumed an increasing importance and corresponding time was devoted 
to their consideration. A manual entitled "Outline of Neuropsychiatry in 
Aviation Medicine," containing material on the more fundamental concepts of 
the dynamics of behavior and the psychopathology of disturbed behavior, was 
issued to the students by May 1944. Only those clinical entities of psychiatry 
were presented that had been found to be of primary importance to the military 
physician. 170 In addition to this manual each student was issued a copy of the 
volume War Neurosis in North Africa by Lt. Col. Roy R. Grinker (MC), 
and Maj. John P. Spiegel, (MC). In order to bring the results of combat ex- 
perience to the classroom, arrangements were made to have either Lt. Colonel 
Grinker (MC), or Maj. Donald W. Hastings (MC), alternately appear as 
guest lecturers before each class to present his experiences and opinions in con- 
nection with activities in the Twelfth and Eighth Air Forces, respectively. 171 

Many attempts were made to obtain suitable motion picture films for 
teaching purposes. Some British films were suggested and, when reviewed, 
were found not to be suitable or adequate for the purposes intended. A few 
excellent recordings of interviews under sodium pentothal were obtained and 
found to be effective as an adjunct to teaching. But in general, neuropsychiatry 
did not lend itself well to the utilization of the ordinary type of training aids. 



184 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Approximately 4,500 medical officers received the type of orientation in 
psychiatry outlined in the foregoing section. Considering that the aim of the 
program was not to produce psychiatrists but rather to produce flight surgeons 
with an understanding of psychiatry, the end result was attained. These medi- 
cal officers had training in psychiatry that made it possible for them to render 
useful service under competent and sympathetic supervision. 

The calibre of the graduates of the School of Aviation Medicine depended 
to a great extent on the quality of the candidates selected for training. The 
answers to the questionnaire sent to medical officers in December 1941 stressed 
the selection of candidates on the basis of intelligence, personality, and interest 
in flying. Colonel Grow, for example, wrote, "I think that every officer sent 
to Randolph Field should indicate his interest in flying and in Aviation 
Medicine." 172 He also noted the need for judgment and diplomacy in handling 
the more or less personal problems which constantly come up in their 
daily work. A few officers felt that too much emphasis should not be placed on 
the flight surgeon's flying. 173 One medical authority held that "only compara- 
tively young, enthusiastic and professionally well prepared officers should be 
selected," and stipulated that no officer over 35 or above the rank of captain 
be sent unless he had "exceptional professional qualifications and a positive 
interest in Aviation Medicine." 174 

In July 1941 it had been recommended by the Commandant that indi- 
viduals over the age of 40 years not be assigned as students in the basic course, 
as such officers had difficulty in maintaining a satisfactory standing in their 
class, and found it difficult to adapt themselves to classroom routine. 175 At this 
time there were no records to indicate that the War Department had ever laid 
down any policy or published any regulations with reference to the qualifica- 
tions of student officers of the flight surgeons' basic course of instruction, other 
than they be medical officers. In 1942, the Commandant, Colonel Reinartz, sug- 
gested that due to the exceptional circumstances medical officers below the age 
of 45 be assigned to the basic course of instruction. He noted: 178 

Such men will be needed as Station Surgeons and they must by necessity have knowledge 
of matters affecting those officers assigned to them as Flight Surgeons and Aviation Medical 
Examiners — this as a wartime measure only. It is further recommended that as Aviation 
Medical Examiners are trained in sufficient quantities, that thought be given to the sending 
to the basic course of instruction of "limited duty" Medical Officers. These officers could 
be trained and being in the "limited" category would not be subject to change. Any station 
having such an officer returned to it, trained as an Aviation Medical Examiner, would not 
again during the present war have to be supplied. This again is a recommendation as a 
war expedient only. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



185 



A study of 97 Army Medical Department student officers who entered 
the basic course at the School on i October 1941 showed that 11.39 P er- 
cent failed to graduate. Of the remainder, 10.4 percent were considered in- 
capable of successfully carrying out all the duties of an aviation medical exam- 
iner and were rated as Class II. Further it was noted that approximately 10 
percent were color blind, 0.05 percent were overweight, 0.02 percent of the 
class were suffering from a nervous or borderline mental disease. 177 

This study of the reasons for student failures by the faculty committee re- 
sulted in the obvious recommendation that students be more carefully selected. 
It was pointed out in the report that not only was money wasted on individuals 
who did not graduate but that many individuals who did graduate were unsuited 
temperamentally to their duties and brought discredit upon the Medical Depart- 
ment through their unwillingness or inability to render satisfactory service. The 
qualities listed as desirable in candidates for the School were as follows: 178 

(1) A desire and willingness to practice aviation medicine. 

(2) An interest in ayiation generally, and a desire to participate regularly and frequently 
in aerial flight. 

(3) Graduation from a Class A Medical School, followed by at least a one-year's rotating 
internship. 

(4) At least six months prior service at an Army post, camp or station. 

(5) A certificate of graduation from or at least one month's training at a Medical Field 
Service School. 

(6) Age of applicant not to exceed thirty-five at time of entering course. 

(7) Excellent physical condition, Class III, AR 40-110 without color defect or visual 
acuity below 20/100 in either eye. 

(8) Aptitude for aviation medicine, or, for better wording, an exhibitor of a person- 
ality which will naturally foster the friendship and inspire the confidence and re- 
spect of flying personnel and which will contain the necessary depth of advice and 
guidance in time of stress. 

It was noted in the report that officers ordered to the School for the course of 
instruction or to duty as flight surgeons against their wishes would not, 
as a rule, provide satisfactory service. It was also reported that pilots had 
little respect for their medical officers who did not care to fly and none for 
their opinions with reference to the medical aspects of flight, and that such 
an attitude on the part of the pilots was incompatible with the successful 
practice of aviation medicine. 179 

On the basis of these recommendations it was directed that the School of 
Aviation Medicine be clearly designated as a postgraduate school for doctors 
who were graduates of a class "A" medical school and who had a minimum 
of 1 year internship. In order to gain admission to the School the Medical 
Corps officer had to be on active duty for a minimum of 3 months; physically 



186 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



qualified for flying duty in physical Class I, II, or III, as prescribed 
in AR 40-110; desire duty requiring regular and frequent participation in 
aerial flights; and be endorsed by his commander as possessing outstanding 
professional qualifications combined with the personality and tact required of 
a flight surgeon. Preference was given to officers who were under 36 years of 
age. 180 Due to difficulty of procuring men qualified from the age and service 
standpoint, men were sometimes selected who did not meet all the requirements; 
this was the responsibility of the surgeon supplying the men for training. 181 

In April 1944 the policy of sending all Medical Corps officers assigned to 
the Army Air Forces School of Aviation Medicine was inaugurated. As the 
need for tactical unit surgeons decreased, other Medical Corps officers were 
assigned in increasing numbers to the School. 182 

It was thought that the training of Negro flight surgeons could be done 
with the least disruption by authorizing an extension course for the group 
it was necessary to train. 183 With the completion of the Flight Surgeon's 
Unit at the Tuskegee Army Flying School, three Negro officers were enrolled 
in the extension course and graduated in February 1943 from the practical 
course. 184 In January 1943, meanwhile, Judge William H. Hastie, civilian 
aide to the Secretary of War, brought to the attention of the Secretary of War 
the fact that Negroes were not admitted to the School of Aviation Medicine 
for the didactic course. 185 The Chief of Air Staff directed that immediate 
action be initiated to provide a proportionate share of vacancies for Negro 
resident students at the School — and qualifying standards for white students 
to apply equally to Negro students. The proportionate share was calculated on 
the basis of the ratio of total white flight surgeons to the Negro flight surgeons to 
be trained. At least one Negro surgeon was to be trained on a resident student 
basis. 186 The first two Negro officers to graduate from the basic course as 
aviation medical examiners were Maj. Harold E. Thornell and Lt. Bascom 
A. Waugh who graduated in March 1943. 187 

Beginning in the spring of 1943 officers from overseas stations were assigned 
to the Aviation Medical Examiners' Course. The great majority of the class 
of January 1945 were from overseas stations, the average service being 24 
months. 

Appropriate examinations were given during the courses at the School and 
the results were considered by the faculty board. When a student fell below the 
accepted standards as determined by the faculty board, he was given an official 
warning by the Commandant. When the 6-weeks course was inaugurated in 
July 1940, the passing level was lowered so that each student before graduation 
was required to be able to perform the physical examination for flying and was 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 187 



Table 8. — AME Students From Overseas 



Hop. 

Li ass 


Number 
in 
class 


Number from 
overseas 
(APO) 


43-B— 8 Mar-3 Jun 1943 


317 


2 


43-C— 19 Apr-15 Jul 1943 - 


310 


11 


43-D— 31 May-12Jul 1943 


319 


49 


43-E— 13 Jul-26 Aug 1943 


264 


38 


43-F— 26 Aug-27 Oct 1943 


210 


11 


43-G— 4 Nov 1943-7 Jan 1944 


139 


43 


44-A— 13 Jan-15 Mar 1944 


161 


56 


44-B— 16 Mar-17 May 1944 


173 


0 


44-C— 25 May-26 Jul 1944 


132 


38 


44-D— 31 Jul-14 Oct 1944 


115 


41 


44-E— 23 Oct 1944-6 Jan 1945 


58 


18 


45- A— 15 Jan-31 Mar 1945 


76 


70 


45-B— 9 Apr-23 Jun 1945 


85 


41 


45-C— 2Jul-15 Sep 1945 


142 


6 



Source: The majority of this class was from the Army Specialist Training Program. Class Rosters, 
AAFSAM Personnel Section. 



required to attain a general average of at least 75 percent in all subjects and not 
below a grade of 70 percent in any subject. 188 

In 1943 the grading system was changed and each student had to be quali- 
fied to perform the physical examination for flying, attain a general average 
of at least 75 percent in all subjects, not fall below a 70 percent in any subject, 
nor below 75 percent in more than two subjects. 189 

Officers failing in the academic work at the School were not ordered to 
the classification centers for duty but were returned to their proper stations. 
Ratings and grades assigned at the classification centers were sent to the School 
in order that the faculty board might award final grades. 190 All certificates of 
graduation came through the School but graduation exercises were held at 
the respective classification centers on the completion of the course. 191 

As it was necessary for the Air Surgeon to recommend station assign- 
ments on the graduation of student officers, and since a small number of them 
could be assigned to work other than as aviation medical examiners, the Com- 
mandant was requested to evaluate them as to their ability as aviation medical 
examiners. 192 Students were placed in categories of Classes I, II and III. Class 
I indicated those officer students who were especially adapted for duty as 

262297°— 55 14 



188 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



aviation medical examiners, Class II indicated those officer students who were 
questionably adapted for duty as aviation medical examiners, and Class III 
indicated the officer students who were not adapted for duty as aviation medi- 
cal examiners. 193 In determining these ratings many factors were considered, 
the most important of which were professional qualifications, and personality 
and psychological traits. 

Beginning in September 1943 each training department was assigned 
groups of student officers. It was the responsibility of the department to 
give an estimate of each individual's military qualifications, the assignment 
for which he was best suited, and to comment upon unusual characteristics 
which limited the individual officer. A questionnaire form was completed 
by the student officer upon his arrival at the School. 194 The procedure was 
modified in April 1944, and a small group of student officers assigned to each 
instructor as advisees. The instructor thus assisted them in their work and 
evaluated them at the same time. 195 Both the questionnaire form and a copy 
of the evaluation card were filed in the Department of Statistics. They were 
coded, carded and punched, ready for any possible future study of aviation 
medical examiners. 196 A report was submitted to the Office of the Air Surgeon 
at the conclusion of each class with a statement of the type of duty for which 
the man was best fitted. This material was available, even though apparently 
not used, prior to assignment. 197 

The policy of sending all Medical Corps officers assigned to the Army 
Air Forces to the School did not affect or modify previous academic require- 
ments. Scholastic standards were maintained at the same high level as they 
had been in the past. The Office of the Air Surgeon originally recommended 
that only in those cases where disciplinary action warranted was an officer 
to be expelled from the School prior to the completion of the course of instruc- 
tion. Unsatisfactory scholastic attainment was noted on the reports concerning 
the officer. Students who did not satisfactorily meet the scholastic standards 
of the School were not to be issued a diploma. 198 In July 1944, however, the 
Commandant recommended that whether or not all medical officers in the 
Air Forces were to be sent to the School, an individual who was not making 
satisfactory progress from an academic standpoint should be failed and re- 
lieved from the course. This view was concurred in by the Air Surgeon. 199 
Students who could not meet the scholastic standards of the School or who 
were considered psychologically unsuited to perform the duties of an aviation 
medical examiner or flight surgeon were relieved from the course. The officer 
who failed met the faculty board which consisted of the Commandant, 
assistant commandant and the chiefs of all academic departments, before whom 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



189 



he had a hearing, and the action of the board was discussed with the officer 
in question. 

Aviation medical examiner ratings were revised in November 1944 be- 
cause it was believed that the ratings then in use had a detrimental effect upon 
the officer and militated against his promotion. 

Table 9. — Medical Examiner Ratings 



Rating 



Satisfactory. . . . 
Very satisfactory 

Excellent 

Superior 



Old grade scale 



75-84 
85-89 
90-94 
95 above 



New grade scale 



75-79 
80-84 
85-89 
90 above 



In May 1945 it was directed that copies of board proceedings and student 
evaluation reports be forwarded for informational purposes to the commands 
to which the officers were returned or reassigned after the completion of 
training. 200 

The School had graduated 559 flight surgeons in the period preceding July 
1940. 201 During the period August 1940 to May 1946, a total of 4,931 medical 
officers were graduated from the basic course for aviation medical examiners, 
practical work at Air Corps stations, or by other authority. 202 A total of 4,129 
flight surgeons or aviation medical examiners was graduated from the basic 
course during the period between Pearl Harbor and V-J Day. 

Twenty-eight foreign officers were graduated as aviation medical exam- 
iners between 24 August 1940 and 3 May 1946. They included representatives 
of Argentina, Chile, Norway, Honduras, Cuba, Bolivia, Mexico, Brazil, Peru, 
Colombia, Uruguay, China, Poland and the Philippines. 203 

Basic factors that contributed to the failure of officers to meet the strict 
scholastic standards were: the officer did not request assignment to the School, 
he did not desire to fly or to become a flight surgeon, or he lacked training and 
background for this type of work. 204 Men were sent to the School who obviously 
were not qualified. Some of these men did not apply to come to the School 
and did not desire to come because of airsickness, fear of heights, chronic sinus- 
itis, or other ailments. 205 During the period when the practical work was given 
at the branch schools most of the failures were in the didactic portion of the 
course. Students who passed the didactic phase but were considered weak 
were so reported to the branch schools so that they might get additional help. 



190 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

Table 10. — Aviation Medical Examiner Graduates — August 1940-May 1946 



Date graduated 



24 Aug 1940. . . . 

19 Oct 1940 

13 Dec 1940 

13 Feb 1941 

29 Mar 1941 .... 
24 May 1941 

23 Sep 1941 

20 Dec 1941 

28 Mar 1942. . . . 

2 Jul 1942 

13 Aug 1942. . . . 

24 Sep 1942 

5 Nov 1942 

17 Dec 1942, 

20 Dec 1942 

28 Jan 1943 - . . . . 
11 Mar 1943.... 

21 Apr 1943 

Total 



Basic 
course 



32 
29 
41 
42 
48 
46 
92 
87 
101 
108 
101 
114 
114 
314 
1 

309 
306 
300 



2,185 



Other 
autb. 



f 22 



22 



Practical 
work at 
AC sta- 
tions 



27 



57 



84 



Date graduated 



3 Jun 1943 

15jull943 

26 Aug 1943... 

7 Oct 1943 

27 Oct 1943 

6 Jan 1944 6 

29jan 1944 c . . . 
17 May 1944 d . . 
15 Mar 1944. . . . 

26 Jul 1944 

14 Oct 1944 

6 Jan 1945 

31 Mar 1945 

23 Jun 1945 

14Sepl945 

24 Nov 1945- • ■ • 

8 Feb 1946 

3 May 1946 

Total 

Grand 
total . . 



Basic 
course 



314 
289 
304 
257 
198 
131 
1 

171 
154 
132 
111 
59 
73 
84 
145 
64 
53 
57 



2,597 



4,782 



Other 
auth. 



24 



Practical 
work at 
AC sta- 
tions 



37 



41 



125 



■ 8th Ind, 17 Mar 1943, Hq, AAF, Washington, DC, 5th Ind, 4 Jun 1943, Hq, AAF, Washington, DC., 
AAFSAM Files 352.183 (Diplomas & Certificates). 

6 AAF Reg 20-27, 12 Nov 1943, effective with this class. 

e Ltr, Air Surgeon, Hq, AAF, Wash, DC, to Comdt, AAFSAM, 19 Jan 1944. 

d AAF Reg 35-52, 13 Apr 1944, effective with this class. 

e Nine men were rated Class III but completed the Academic work. 

f 1st Ind, to 7th Air Force, 27 Aug 1942, and 2nd Ind, Hq, AAF, Washington, DC, 15 Mar 1943 to Ltr, 
Hawaiian Dept, Fort Shafter, T. H., 11 Jan 1943, AAFSAM Files 352.183 (Diplomas & Certificates). 

When, in May 1943, the Office of the Air Surgeon was experiencing con- 
siderable difficulty getting satisfactory medical officers for the Aviation Medical 
Examiners' Course, a study was made to see whether the age limit of 35 years 
could be raised. As can be seen from the study of the 1,135 students who took 
the course from 14 December 1942 to 15 July 1943, the younger students made 
slightly better grades. 206 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 
Table 11. — Failures AME Course in Fiscal Years 1941-1945 



191 



Reason 



Academic failure 

Psychological 

Disciplinary 

Physical 

Course interrupted by Government orders 
Relieved at own request 



Total . 



1941 

5 
1 



1942 



26 



1943 

27 
7 
4 
3 
2 
1 



44 



1944 



33 
19 
4 
3 
1 



60 



1945 



10 



Totals 



79 
33 
16 



9 
1 



146 



Source: Annual Reports, AAFSAM, 1941-1945, AAFSAM Files 319.1 (Annual Report). Report of 
Graduates, AAFSAM, AME, 1940-1945, AAFSAM Files 353.17 (Graduates Aviation Medical Examiners). 

The policy established in reference to the ratings of former graduates of the 
School of Aviation Medicine if called to extended active duty was as follows: If 
not called to extended active duty with the Army Air Forces no action was 
necessary; or if called to extended active duty with the Army Air Forces those 
qualified could be given the current authorized ratings. 207 

After July 1940 the graduates of the School of Aviation Medicine were 
rated aviation medical examiners and time spent in completing the course 
counted as part of the year of active duty with the Air Corps necessary for the 
rating of flight surgeon. 208 In 1941 it was decided that the aviation medical 
examiner who served a minimum of 1 year of active duty with the Army 
Air Forces after having received such qualifications and who demonstrated 

Table 12. — Didactic Grades by 3-Year Age Groups* 



Age group 



All ages. . . . 
26 and under 

27-29 

30-32 

33-35 

3<K38 

39-41 

42 and over. 



Number 



1, 135 
34 
308 
303 
274 
135 
59 
22 



Percent 



100.0 
3.0 
27.1 
26.8 
24.1 
11.9 
5.2 
1.9 



Average 
grade 



85.6 
88.3 
86.9 
85.8 
85.0 
84.0 
83.4 
84.2 



*Ibid. 



192 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



possessing the required qualifications might be rated a flight surgeon. 209 In 
addition to a year of active military service the aviation medical examiner 
was required to have 50 hours official flying time in military aircraft and be 
familiar with an approved reading list. 210 On 31 July 1942 AAF Regulation 
No. 25-5 specified that aviation medical examiners who served a minimum 
of 6 months' active duty with Army Air Forces installations and demonstrated 
the qualifications of a flight surgeon could be so rated. 211 

Due to the inauguration of the 12-week course the Commandant recom- 
mended that the rating of aviation medical examiner be discontinued; that 
the graduates of the School of Aviation Medicine be rated flight surgeons; 
and that the rating of acting flight surgeon be authorized. He believed that 
the designation of aviation medical examiner could not be justified in view 
of the much improved training at the School. 212 

The status of Flight Surgeon [he stated] is the one recognized and sought by all who 
aspire to continue service with the Army Air Forces. This being true, it is felt that some 
recognition should be given those officers who are on active duty with the combat forces 
which in the minds of both the Medical Officers and the Officers of the Army Air Forces 
connotes Flight Surgeon. This could be a designation such as "Acting" Flight Surgeon. 
For those Medical Officers assigned to duty with the Army Air Forces outside the con- 
tinental limits of the United States or in the combat zones, this should confer all the rights, 
privileges and emoluments that the designation of Flight Surgeon confers upon those having 
graduated from the School of Aviation Medicine. The individuals so rated as Acting 
Flight Surgeons, upon return to the United States, would be sent to the School of Aviation 
Medicine, there to receive the theoretical portion of the work, which they had in actuality 
in the field. 

On 2 March 1943 AAF Regulation No. 25-5 provided that to qualify as 
a flight surgeon, an aviation medical examiner must have served satisfactorily 
as such with an Army Air Forces installation for one year subsequent to 
graduation as an aviation medical examiner or the number of hours of flying 
in a military aircraft. 213 

Graduation from the School of Aviation Medicine did not, however, auto- 
matically qualify medical officers as aviation medical examiners. After success- 
fully completing the course the graduates were required to submit applications 
for ratings through channels to the Commanding General, Army Air Forces. 214 
An aviation medical examiner could be designated a flight surgeon if he 
demonstrated that he was qualified to perform such duties as were required 
of a flight surgeon and fulfilled one of the following service requirements. 215 

(a) Has satisfactorily served not less than 1 year with the AAF subsequent to 
designation as an Aviation Medical Examiner, and has flown in military aircraft 
at least 50 hours subsequent to designation as an Aviation Medical Examiner; or 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



193 



(b) Is assigned as an Aviation Medical Examiner to an AAF unit which is serving 
outside the continental limits of the United States; or 

(c) Has served with an AAF unit outside the continental limits of the United States 
since 7 December 1941; and has subsequently completed the prescribed course 
for Aviation Medical Examiners at the AAF School of Aviation Medicine. The 
one-year time requirement outlined in (a) above will be modified by giving 
credit for the time served outside the continental limits of the United States 
on a month-to-month basis; however, in all such cases a Medical Corps Officer 
will be required to serve a minimum of 3 months as an Aviation Medical Ex- 
aminer, subsequent to completion of the prescribed course for Aviation Medical 
Examiners at the AAF School of Aviation Medicine. Evidence will be furnished 
that the applicant has flown 50 hours in military aircraft while on duty with the 
AAF. 

The extension course had been established in 1923 to give theoretical instruc- 
tion to medical officers of the Regular Army, National Guard of the United 
States and Reserve Corps who were unable to attend the basic course. The 
satisfactory completion of the extension course on an average required 2 years. 
The extension course was divided into four subcourses : 216 

Subcourse I. Ophthalmology and Otolaryngology 51 hrs. 

Subcourse II. Aviation Medicine 75 hrs. 

Section 1. Cardiology 25 hrs. 

Section 2. Physiology 25 hrs. 

Section 3- Administration 25 hrs. 

Subcourse III. Psychology 60 hrs. 

Subcourse IV. Neuropsychiatry 65 hrs. 

Section 1. Psychoneuroses and Neurology 40 hrs. 

Section 2. Psychoses 25 hrs. 

On 24 September 1940 The Adjutant General approved the suspension 
of the extension course for "officers not actually in active duty with the Regular 
Army, Officer's Reserve Corps, or National Guard, excepting those on the in- 
active list who are at this time enrolled." 217 In October 1940 the Chief of the 
Air Corps was authorized to qualify, and The Surgeon General to rate, as avia- 
tion medical examiners those Medical Corps Reserve officers on extended active 
duty who, within the preceding 5 years, had satisfactorily completed the ex- 
tension course at the School of Aviation Medicine, and who had satisfactorily 
completed at least 6 weeks' practical instruction under a qualified station 
(flight) surgeon. 218 A War Department directive of 18 August 1941 ordered 
the discontinuance of the extension course to all new enrollments and provided 
for the cancellation of the enrollment of all students who had not completed 
Subcourse I, as well as those who had not completed the same with satisfactory 



194 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



grades as determined by the Commandant. 219 The only exception was for 
designated foreign students and for this reason the number of students engaged 
in this work was extremely small. 

Ninety-nine officers were graduated as aviation medical examiners after 
completing the practical work at the Army Air Corps stations during the 
period September 1941 to November 1945. 220 Of the 80 officers who completed 
the extension course in the fiscal year 1942, 33 became aviation medical exam- 
iners and 38 others were on active duty with the Army Air Forces. 221 Two 
Latin- American officers graduated from the extension course during this period: 
Dr. Waldemar Lins Filho, Brazil, in 1941, and Dr. Luciano Benjamin de Vinei- 
ros, Brazil, in ig^. 222 

The following statistics exhibit the work performed in the extension course, 
fiscal years 1941-1945. 223 Three individuals from the Republic of Cuba were 
the only students in the extension course in 1945. 224 



Table 13- — Extension Course, Fiscal Years 1941-1945 



1942 



1943 



Total enrollments carried forward from class of last 

school year 

GAINS: New enrollments during the entire school year. 
Reinstatements during the entire school year 

Total 

LOSSES: Cancellations, failure to complete quarterly 

minimum req 

Cancellations, other causes 

Students completing entire extension course 

Total 

Total enrollments remaining at end of school year 

Total lesson assignments completed during past school 

year 

Monthly average 

Total subcourses completed during past school year 

Total subcourses completed during past school monthly 

average 



546 
25 
2 



573 



388 
38 
80 



506 



67 

5, 258 
438 
382 

32 



67 
5 
0 



72 



32 
11 
24 



67 



1,004 
84 
73 



Source: Rpt. of Graduates, AAFSAM, AME, Jul 44-Jun 45. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



195 



In November 1945, interest in the extension course was renewed and plans 
were made to offer this training during the postwar period. After a study of 
the statistics and history of the extension course the Commandant recommended 
that, "the Extension Course in Aviation Medicine be not reconstituted, and that 
all training leading to the rating of Aviation Medical Examiner or Flight 
Surgeon be conducted in residence at the AAF School of Aviation Medicine," 225 
In spite of this recommendation, however, the extension course was reinstated 
in March 1946. 226 

In April 1942, meanwhile, the War Department authorized a School of 
Aviation Medicine in the Hawaiian Islands to qualify medical officers as aviation 
medical examiners. These officers, as squadron surgeons, had demonstrated 
their fitness as flight surgeon. 227 The course was to consist of 6 weeks' didactic 
and 6 weeks' practical work, and the subjects taught were to be essentially those 
given at Randolph Field. 228 The actual training consisted of 96 hours of inten- 
sive class work at Hickam Field and practical instruction in the fighter com- 
mand and the bomber command, spread over a period of 4 months. 229 The 
Air Force surgeon furnished the School with all grades so that the School could 
issue the certificates of graduation. 230 The course was considered the equivalent 
of the correspondence work and 22 graduates of this branch school in the 
Hawaiian Islands were given the rating of aviation medical examiner. 231 

In September 1942 the Eighth Air Force wanted to have rated as medical 
examiners those officers who satisfactorily completed the course of instruction 
at the Eighth Air Force Provisional Medical Field Service School and who served 
4 months with a tactical unit in the theater. The course of instruction at this 
school was 2 weeks in length during which time the following subjects were 
taught: Military Field Medicine, Care of the Flyer, and the Technique of the 
Examination for Flying. But the request that the school be officially consti- 
tuted a branch of the School of Aviation Medicine 232 was refused on the basis 
that it was not in keeping with the policy of centralizing and standardizing all 
training in aviation medicine at the School of Aviation Medicine. Similar re- 
quests for schools in India and Australia ware disapproved. 233 

In concluding this description of the advanced study courses of flight 
surgeons and aviation medical examiners, mention must be made of the fact 
that one of its benefits was that of developing in medical officers an esprit de 
corps and a unity of purpose that was of great importance to the success of the 
AAF medical program. 234 

Yet, in spite of all attempts to keep the course of study up-to-date, a gap 
existed between the flight surgeon in the field and the School. Suggestions con- 



196 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



cerning the appointment of liaison officers to the various combat theaters as 
representatives of the School were not put into practice. 235 However, after Gen- 
eral Reinartz, the Commandant, returned from a trip to the battle front in 
North Africa he was able to summarize the attempts of the School to keep close 
contact with conditions at the front as follows: "As a result of my trip I was able 
to say that the curriculum at the School of Aviation Medicine was adequate; 
that we were keeping abreast; and that I had actually seen the practices of the 
School of Aviation Medicine put into effect in the war zones." 236 

Questionnaires filled out by 2,591 returnees from all overseas Air Forces 



doing work that received 
Tjlie most frequent comments 
light surgeon dealt with his 
Other important contribu- 
on the physiologic problems 



indicated that the squadron flight surgeon was 
favorable comment in 71.6 percent of the cases, 
in which some specific value was attributed to the 
ability to recognize and treat operational fatigue, 
tions by the flight surgeon concerned instruction 
of high-altitude flying; first-aid, survival, and emergency procedures; presence 
at briefings, take-off, and landings; personal interest in the welfare of the 
men, including the grounding of men, recommendations for rest, and keeping 
men in condition to fly; and services as a psycho ]< 
builder. Only 15 percent of all the comments made by returnees indicated 
dissatisfaction with the flight surgeon. These unfavorable comments referred 
to lack of medical knowledge or ability, lack cf interest, and attention or 
personal characteristics of the flight surgeon. The study indicated that in 
some cases squadron flight surgeons were unable to ground men due to actions 
of the commanding officer or group surgeons. 237 It was evident from this 
study that when the flight surgeon manifested what the combat men considered 
a proper orientation toward their problem, there was no concern over whether 
or not he actually flew in combat with his men. The study concluded that the 
flight surgeons had indeed made an important contribution to the winning of 
the war in the air; that by their preoccupation with the personal problems of 
the flyer they played an essential role in maintaining the morale and efficiency 
of AAF combat men. 238 No small measure of the success of the flight surgeon 
was due to the excellent training these officers received at the School. 



Advanced Study for Altitude 

The High-Altitude Indoctrination and Classific[at 
Air Forces personnel set forth in the directive 19 
later in this chapter, ultimately required the s< 
officers. The Air Surgeon decided to employ, inscjfar 
who would supervise altitude chamber flights and 



Training 

ion Program for the Army 
March 1942, and discussed 
;s of more than 200 trained 
as possible, physiologists 
iive lectures on high-altitude 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



197 



flight under the responsibility of a medical officer. The officer personnel were 
carefully selected, one prerequisite being a doctor of philosophy degree in 
physiology, biology or the allied sciences. A number of selected medical 
officers also were trained because the demand for physiologists exceeded the 
supply. 

It was thought at first that these specialists should be ordered to the 
Mayo Clinic for a i-month training period and then sent to one of the replace- 
ment units or to the School of Aviation Medicine for a few weeks of additional 
practical training prior to their assignment to an actual High-Altitude Indoc- 
trination and Classification Unit. 239 However, on 3 July 1942, the Commandant 
was directed to initiate a course of instruction in aviation physiology, 240 and it 
was decided that all newly commissioned aviation physiologists would attend 
the course. The program, following directives dated 19 June 1942, 241 stressed 
the procedure of establishment of an altitude training unit, altitude-chamber 
operation, and problems of high-altitude physiology. As the units were estab- 
lished the course was broadened to include practical problems of the use and the 
abuse of oxygen equipment, and indoctrination procedures, including lectures, 
demonstrations and chamber flights. 

The course material included some training in military customs, drill, 
organization of the Air Forces, and administration and supply as associated 
with the operation of an altitude training unit. Practice in aircraft identi- 
fication, fundamentals of aircraft operation, and link trainer instruction were 
given with the cooperation of Air Force personnel. The study of physiology 
of high-altitude, the operation of oxygen equipment, and the special problems 
related to military aviation were emphasized. The practical work in the actual 
operation of the altitude chamber, including the technique of conducting 
indoctrination and classification flights occupied a prominent portion. As 
materials became available, the course included the study of emergency equip- 
ment and the technique of carrying out such emergency procedures as bailing 
out, forced landings, and arctic and jungle survival. 242 An important phase of 
the instruction covered the study of the physics of the atmosphere, physiology 
of respiration, anoxia, effects of gas expansion, decompression sickness, collapse 
at high altitude, effects of acceleration and cold and the use of protective 
equipment. 243 As time went on this 5-week course was repeated with an interval 
of varying length between classes depending upon the availability of students. 
No classes were held during the early part of 1944, as the quota of personnel 
for altitude training units had been met. It was believed that the few re- 
placements required could be trained by the altitude training unit where they 
were needed. 244 



198 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



The requirements for additional personnel, however, resulted in the re- 
sumption of the Aviation Physiologists Course in November 1944. In addi- 
tion to the former course, 5 days were spent at the San Antonio Aviation 
Cadet Center for the purpose of observing the operation of an altitude training 
unit, and for observing special demonstrations of the use and maintenance of 
personal equipment. 245 A parachute-landing course of 12 hours was substituted 
for physical training during this class. 246 A group of 14 was recruited from the 
preceding aviation medical examiner's class, all but one of whom were volun- 
teers. The course was of 3-weeks' duration: from 20 May 1946 to 7 June 1946. 

Since these men were to be assigned to the Training Command for the 
purpose of establishing and organizing new training units in the field, it was 
essential that their training be of an extremely practical nature, omitting some 
of the detailed basic physiology of the wartime course. It was believed that 
this omission would not seriously detract from their understanding of the 
physiological problems of flight inasmuch as they had already received that 
information as a part of the AME curriculum. 

Emphasis was placed upon the organization and functions of the physiolog- 
ical training unit and integration into other ground and flying training activi- 
ties, the demonstration and practice in the use of oxygen and night-vision train- 
ing equipment, pressure-breathing and explosive-decompression oxygen acci- 
dents in aircraft and in-flight emergency procedures, acceleration problems, and 
medical problems to be encountered in the unit. In addition, demonstrations 
were arranged of the AAF type G-suit, oxygen installations in aircraft, and 
a high-altitude B-29 mission during which in-flight emergency oxygen pro- 
cedures were practiced. 247 

An attempt was made to incorporate into the training of these aviation 
physiologists the information obtained and the recommendations made in the 
medical evaluation program report on the wartime altitude training pro- 
gram. 248 

Among the special programs offered was that in high-altitude physiology 
and oxygen equipment. In June 1942 the San Antonio Air Depot had only 
200 oxygen masks on hand, and training in oxygen equipment was at a low 
level in the advanced flying schools. Although it was realized that the per- 
sonnel at the advanced flying schools needed oxygen training it was decided 
to wait until the Unit Oxygen Officer's Course at the School of Aviation 
Medicine was developed and to train combat personnel first. 249 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



■Urn 



One of the very First low-pressure chambers. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROCRAMS 



203 



Altitude chambers were located within the Army Air Forces Flying Train- 
ing Command at all preflight and flexible gunnery schools instead of at basic 
flying schools, as originally planned. This left a long period of time between 
indoctrination and combat, so it was thought advisable to review the physiolog- 
ical effects of high altitude and the use of oxygen equipment during an ad- 
vanced phase of training in which the student actually began its use.'" 50 There 
was need for a group of flight surgeons who would be specially assigned to ad- 
vanced flying schools where it would be their duty to lecture to students on the 
physiological effects of high altitude, and to cooperate in every way with unit 
oxygen officers in the fitting of oxygen masks and instruction in the use of this 
and other allied equipment. As Col. Charles R. Glenn (MC), Surgeon of the 
Training Command, stated: 251 

Their duties are definitely not to be those of Unit Oxygen Officers. They will lecture 
only when called upon to do so by training directives or upon request of the Commanding 
Officer of the station. If formal lectures are not given, these officers should, by close asso- 
ciation with flying officers and students on the flying line and elsewhere, attempt to arouse 
interest in, and disseminate knowledge concerning the necessity for oxygen and how to use it. 

The Army Air Forces Training Command sent the first group of flight 
surgeons to the School of Aviation Medicine on 7 December 1942. 2 The course 
was given every 2 weeks and each session lasted 10 days. 

Indoctrination of the flight surgeon in the problems of the air crewmen 
was stressed. Every effort was made to bring the flight surgeon and the unit 
oxygen officer into contact. In order to accomplish this, the medical officers 
took the Unit Oxygen Officer's Course the first week. During the second 
week, additional lectures were given on the physiological aspects of high- 
altitude flying, the use of emergency equipment, the special problems of the 
flight surgeon in combat areas, and upon the preparation of the lectures which 
the flight surgeons were to give on return to their proper stations. Additional 
contact with students was obtained by having small groups of flight surgeons 
take part in the experimental cadet runs which were being conducted evenings 
in the altitude chambers. During the period 7 December 1942 to 2 October 
1943 a total of 378 medical officers completed the course. The special course 
in High Altitude Physiology and Oxygen Equipment was discontinued on 
2 October 1943 when all designated officers had completed the training. 

Since the inception of the Altitude Training Program, the problems of 
acceleration were an essential part of instruction. Aviation physiologists in 
altitude training units dealt with the physical principles of acceleration, the 
dangers to pilots and aircrews who were exposed to excessive centrifugal forces, 
the methods for minimizing deleterious effects of the various types of accelera- 

262297°— 55 15 



204 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

tion, and the various devices which had been developed for the protection of the 
pilot and aircrew against excessive ground forces. Such instruction was allotted 
approximately one hour in the didactic lectures given as introductory material 
prior to the flights in altitude chambers. Review of the principles of flight for 
fighter pilots was conducted in the advanced single-engine, transition, and 
advanced twin-engine transition schools (pilot), since T. C. Memorandum 
50-0-3 was first published in 1942. 

Special instruction was conducted at the fighter gunnery schools, such 
as Foster Army Air Field, where some of the first anti-G suits were tested and 
used in the demonstration of fighter tactics for pilots undergoing training 
there. Such instruction was particularly effective and important in dive 
bombing tactics, rocket firing maneuvers and other fighter tactics requiring 
abrupt pull-outs and moderately persistent exposure to the effects of acceleration. 

Although such anti-G training had been conducted during the preceding 
few years, it was considered necessary, in view of the changing tactics of 
fighters and fighter bombers utilizing new type missiles, rockets and other 
such modern ordnance, to develop a well-wrought, progressive training pro- 
gram dealing with anti-G problems. Therefore, in mid-1945, a War Depart- 
ment directive 253 was published stipulating the training requirements con- 
cerning the problems of acceleration. This directive proposed to give the 
fighter pilot a clear understanding of the physical forces involved in accelera- 
tion during flight; to instruct trainees in the subjective symptoms and the 
physiological changes produced by mild to excessive G forces on the human 
body; and, finally, to familiarize AAF fighter pilots with the operation and 
the use of most of the types of AAF type G-suits. 

Instruction in anti-G problems was conducted and supervised by aviation 
physiologists assigned to the various altitude training units in the AAF Train- 
ing Command. The introductory didactic instruction was accomplished at 
the preflight and the flexible gunnery schools. A special training and research 
program was instituted at Foster Army Air Field, inasmuch as graduate, pilots 
who had been selected to instruct other fighter pilots were assigned to Foster 
Field for an advanced course in fighter gunnery tactics. It was at Foster 
Field that such highly selected fighter pilots were trained in the principles 
and use of newest type G-suits in order that they might, in turn, transmit such 
instruction to their future students. 

One of the most important phases oi the Anti-G Training Program in 
the Training Command was conducted by aviation physiologists and altitude 
chamber technicians of the Altitude Training Unit at the AAF Combat Crew 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



205 



Processing and Distribution Center, Lincoln Army Air Field, Lincoln, Ne- 
braska. In addition to further instruction in the use of anti-G equipment, all 
fighter pilots were fitted and issued the newest type G-suit during their proc- 
essing at Lincoln Army Air Field prior to their transfer to stations of the 
continental Air Forces. The training program and the supply system were 
organized at Lincoln Army Air Field in July and August 1945. 254 

Advances in the development of oxygen equipment and ideas supplied by 
captured German equipment were brought to fruition with the development of 
demand oxygen equipment. This new equipment was radically different and 
far better than that previously in use in the Air Forces. It was complicated in 
comparison to previous equipment and required instruction of personnel in its 
use if it were to be used efficiently. It was desired, too, to use this equipment as 
soon as possible and to replace all constant-flow equipment in combat aircraft. 
Since obviously some widespread means was needed to assure the proper indoc- 
trination of flying personnel, it was decided that if one officer in each squadron 
could be trained properly, he, in turn, could instruct other individuals in his 
organization. This individual was to be known as the unit oxygen officer. 

On 3 July 1942 the School of Aviation Medicine was directed to assume 
responsibility for the special course of instruction of unit oxygen officers which 
had previously been conducted for three weeks at the Aero Medical Research 
Laboratory, Wright Field. 255 The course for unit oxygen officers was inaugu- 
rated at the School of Aviation Medicine 6 July 1942 and was repeated each 
week thereafter except for the weeks beginning on 11 April and 13 June 1943. 
Instruction was given in the pressure-chamber building and in the building 
formerly used as the hospital mess hall and a building designed as a hospital 
ward. The first of the two interruptions occurred when a special course was 
given to twenty-eight instructors of the Technical Training Command. An 
oxygen engineer from the Aero Medical Laboratory was ordered to the School 
for this period to help organize the special material to be presented to this 
group. 256 The second interruption in the Unit Oxygen Officers' Course schedule 
came when it was decided to use the facilities and personnel to give the aviation 
medical examiners their oxygen indoctrination. It was recommended that the 
Unit Oxygen Officers' Course be given five out of six weeks as this arrange- 
ment would provide teaching personnel and facilities to provide the aviation 
medical examiner a more thorough oxygen indoctrination. 257 

The original five-day Unit Oxygen Officers' Course consisted principally 
of lectures on the physiological aspects of high-altitude flying, demonstrations 



206 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



of essential oxygen equipment, and altitude chamber flights. The course was 
revised 258 as reports from the theaters and elsewhere indicated the need for 
change, and as demonstration equipment became available. 

AAF Regulation No. 55-7, dated 30 May 1942, provided that the first 
assistant operations officers in each combat group and squadron be designated 
as unit oxygen officer. 259 Later any officer of the operations section could be so 
designated. 260 The unit oxygen officers were drawn from several components 
of the Army Air Forces and included flying personnel and ground officers. 
As of September 1942, 80 percent of the unit oxygen officers were flying 
personnel. 261 

In May 1943 ^ c un ^ oxygen officer became in fact the unit equipment 
officer trained in the use of oxygen, protective and emergency equipment. 
He became responsible for fitting oxygen masks and inspecting oxygen equip- 
ment; acted as technical adviser to the commanding officer in regard to the 
issue and maintenance of protective flying equipment and functioned as a 
training officer in emergency procedures. 262 In order to prepare him to carry 
out these duties the unit oxygen officer was trained at the AAF School of 
Aviation Medicine in the use and maintenance of the following: oxygen equip- 
ment, such as masks, regulators, cylinders and installation accessories; pro- 
tective equipment, including safety harness and flying clothing; and emergency 
equipment, such as aeronautic first-aid kits, emergency ration kits, life rafts, 
and parachute packs. In addition to the training in physiology of altitude and 
special equipment, lectures and demonstrations were given on night vision, 
supply procedures, ditching procedures, prevention of aero-otitis, areo-sinusitis 
and hearing fatigue, emergency rations, high-G forces and carbon monoxide. 
The study of aircraft oxygen installation was facilitated by a tour of the San 
Antonio Air -Depot and by training films. 263 To meet the actual needs in 
combat zones, lectures on conditions of the eye, ear, nose and throat were 
eliminated from the course of study in 1943 in order to allow more time for 
actual physical manipulation of oxygen installations. 264 

Criticism from the combat zones indicated that oxygen officers previously 
trained were unsatisfactory because of the following reasons: lack of interest, 
too actively engaged in flying duties, became casualties in battle and left units 
without an oxygen officer, and lack of mechanical knowledge in general and 
oxygen systems in particular. It was evident that the flying officers were too 
preoccupied with the business of carrying the war to the enemy to serve as unit 
oxygen officer. They were killed or wounded in action and the squadron in 
which they served was left without anyone for this important phase of their 
work. It was realized on the other hand that nonflying officers would need to 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



207 



be tactful and be backed by inflexible regulations and a commanding officer 
who understood the oxygen officer's problems. Not only did this criticism result 
in changes in the course of study that made it more practical but it resulted in 
the recommendation that the oxygen officer be mechanically minded and a non- 
flying officer and that the scope of his duties be more carefully and definitely 
defined. 265 

As a result of the observations of General Reinartz during his inspection 
trip to North Africa and England, the Commandant decided a study should 
be made concerning the assignment of unit oxygen officers. 266 The results of 
a questionnaire sent to graduates of the Unit Oxygen Officers' School indicated 
that they were not accomplishing the missions for which they were trained. Of 
the 190 questionnaires returned, only 107 officers indicated that they were en- 
gaged in oxygen indoctrination and of the 99 stations concerned only 72 
were accomplishing any indoctrination work. A wastage of effort of 27.3 per- 
cent of the stations and 43.6 percent of the individuals was indicated by this 
report, apparently resulting from the fact that commanding officers were not 
fully cognizant of the importance of oxygen indoctrination. 267 It was recom- 
mended therefore that commanding officers be informed of the duties of the 
unit oxygen officers and advised to direct their oxygen officers to perform these 
duties; that training films, oxygen equipment and mock-ups be assigned to 
each station for use in instruction; and that the oxygen mask be made an item 
of personal issue. 268 In an attempt to correct the over-all situation, AAF Regu- 
lation No. 55-7 issued 4 May 1943 stated : 2 ''° 

Each combat unit commander will be held particularly responsible for "oxygen dis- 
cipline" in his unit. Each group or squadron commanding officer of an activated and con- 
stituted flying unit will designate an officer of his operations section as Unit Oxygen Officer. 
Only in unusual circumstances will an officer other than a graduate of the AAF Unit 
Oxygen School be appointed as the Unit Oxygen Officer. 

A total of 1,851 unit oxygen officers graduated from t he AAF School of 
Aviation Medicine during the period July 1942-October 1943 (Table 14). 

The Eighth Air Force on 19 March 1943 created the first unit equipment 
officers. Appointed from each group headquarters and each squadron of the 
Eighth Bomber Command, these were ground officers who had been trained at 
the Eighth Air Force Provisional Field Service School 270 In the Zone of 
Interior, meanwhile, a new course was inaugurated when the duties of the 
oxygen officer were expanded and it was directed that the new personal equip- 
ment officer be a nonflying officer. The 2-week course of instruction was begun 
on 15 November 1943, replacing the Unit Oxygen Officers' Course. 



208 



MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

Table 14. — Unit Oxygen Officer Graduates 



Class 
beginning 



1942 

6 Jul... 

13 Jul.. 
20 Jul. . 

27 Jul.. 
3 Aug . . 
10 Aug . 
17 Aug. 
24 Aug. 
31 Aug. 

7 Sep. . . 

14 Sep. . 
21 Sep.. 

28 Sep. . 
5 Oct... 
12 Oct.. 
19 Oct.. 
26 Oct.. 
2 Nov.. 
9 Nov. . 
16 Nov. 
23 Nov. 
30 Nov. 
7 Dec... 



AC 



34 
33 
31 
30 
40 
35 
36 
29 
27 
25 
23 
17 
18 
12 
16 
23 
25 
18 
22 
23 
30 
23 
28 

14 Dec ! 28 

21 Dec ; 31 

28 Dec... 



1943 



4 Jan 


14 


11 Jan 


18 


18 Jan 


24 


25 Jan 


28 


1 Feb 


20 



24 



MC 



OD 



OMC 



Grad- 
uates 



37 

35 
32 
31 
46 
35 
37 
29 
27 
25 
23 
17 
18 
13 
16 
23 
25 
18 
22 
23 
30 
35 
29 
31 
32 
26 



22 
24 
29 
20 



Class 
beginning 



1943— Con. 

8 Feb 

15 Feb.... 
22 Feb.... 

1 Mar. . . . 

8 Mar. . . . 

15 Mar. . . 
22 Mar. . 
29 Mar. . . 
5 Apr. . . . 
12 Apr. . 

18 Apr. . . 
26 Apr. . . 
3 May. . . . 
10 May. . . 
17 May... 
24 May. . . 
31 May. . . 

7Jun 

21Jun... 
28Jun.... 

5 Jul 

12 Jul. . . . 

19 Jul.... 

2 Aug.... 

9 Aug.... 

16 Aug . . . 



30 Aug. 
13 Sep. . 
20 Sep.. 
27 Sep. . 
4 Oct... 



AC 



MC ! OD 



OMC 



18 3 
18 8 
21 5 
20 4 






. . . . 


.... 










22 3 
20 1 
27 7 
14 2 
28 














i 





Grad- 
uates 



EM Class — no diplomas 



27 
21 
17 
27 
29 
36 
25 
41 
49 
43 
50 
46 
40 
58 
41 
64 

24 
34 
45 
40 
42 



21 
26 
26 
24 
25 
21 
34 
16 
28 

s 
29 
22 
20 
28 
31 
36 
28 
41 
49 
43 
50 
46 
40 
58 
41 
64 



24 
34 
45 
40 
42 



Total 1,851 



Source: 1st Ind, Comdt, 27th AAF Base Unit, AAF SAM to CG, AAF, Director of Adminis tration, Office 
of Air Surgeon, Washington, D. C, 20 Sep 1944, to basic ltr. Director of Administration of Comdt, AAF 
SAM, 16 Sep 1944, SAM Files 352.15 (Students, General). 

Book of Graduates, AAF SAM 1943, VOC, SAM Records Section. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



209 



The instruction at the School was designed to achieve the following ob- 
jectives: to give the personal equipment officers a clear understanding of their 
functions, the importance of their duties, and their relation to others respon- 
sible for related duties; to give the personal equipment officers a knowledge 
of such elementary physiological principles as were necessary for an appre- 
ciation of the need for the various items of equipment and for their proper 
use; to impart a familiarity with the construction and use of equipment, the 
reasons for its design, elements of weakness which might make for failure, 
and methods of test and repair ; and to give a full realization of the necessity 
for the proper care of equipment and a familiarity with approved means for 
storage and control. The personal equipment officer was also familiarized 
with the simple physiological basis for procedures employed in emergencies 
such as crashes and ditching, together with a working knowledge of such 
procedures and an understanding of the means whereby these objectives could 
be accomplished in the squadron, groups, or wings to which these officers 
were assigned. 271 

In order to provide instructors for the new course, aviation physiologists 
were assigned to take the course and then remain for 2 weeks to help as 
instructors. 272 This system of rotating lecturers proved to be detrimental to 
the course. The physiologists did not take as much interest in improving the 
course or in carrying out their assigned work as did permanent instructors. 
The visiting personnel regarded their duty with the Personal Equipment 
Officers' Course as a breather from their own duties at their home station. 273 
During several classes about 15 percent of the officers were medical officers, 
a few diplomates of the American Board of Surgery. As the Director of the 
course stated : "The Personal Equipment Officer is a title and not a position." 274 

The lack of certain essential equipment made it difficult to give adequate 
training. The only ditching drill the students observed was in the British 
film, "Prepare for Ditching." Due to lack of facilities the students had no 
opportunity to see or practice stowage of equipment in fuselages, escape-hatch 
drill or other air-sea rescue procedures. 

In November 1943 the School requested for the second time that it be 
provided with salvaged fuselages so that actual demonstrations of aircraft oxygen 
installations and fire-extinguisher systems, stowage problems, dinghy drill, 
emergency hatch-escape drill, and air-sea rescue procedures could be taught. 275 

By January 1944, the problem of inadequate and insufficient equipment 
had been partially solved. Extensive use was made of wall mock-ups, installa- 
tion diagrams, cutaway sections, films, emergency sustenance kits, protective 
clothing and all available visual and practical aids. Refrigerated chamber runs 



210 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Nvere made to demonstrate the correct use of clothing, hazards of improper use 
and care of clothing. 276 Dinghy drill in the Randolph Field swimming pool 
using A-3 rafts, SCR 578-A (Mae West) radio, pyrotechnic equipment, water 
drills and heavy flying clothing were included in the training program. 
Mimeographed notes, technical orders and other publications were given 
the students for future reference. These mimeographed notes were the basis 
for the Manual for Personal Equipment Officers later published at the AAF 
School of Applied Tactics. 277 

The Personal Equipment Officers' Course was conducted at the AAF 
School of Aviation Medicine from 15 November 1943 to 12 February 1944. 
During this period 409 students graduated from this course. 278 A total of 24 
officers failed to finish the course satisfactorily with their class. During the 
early portion of the course many officers reported late and finished only a portion 
of the course. 279 

The Personal Equipment Officers' Course closed at the AAF School of 
Aviation Medicine 12 February and opened at the AAF School of Applied 
Tactics, Orlando, Florida, 6 March 1944. 280 Certain of the personnel from the 
School were transferred with the course. 

Implementing the Altitude Training Program in the AAF 

The mission of the AAF Altitude Training Program was to familiarize 
flying personnel with the physiological principles involved in ascent to high 
altitude, to indoctrinate them in the use of oxygen equipment, and to establish 
their confidence in the adequacy of oxygen equipment in a rarefied atmosphere. 
During the war years altitude training units established in the training com- 
mands and continental air forces were directed by officer personnel selected on 
the basis of an academic background in physiology or allied biological sciences. 
The training curriculum was based on directives issued by the Air Surgeon. 281 

Combat crews in training received their initial altitude training in the AAF 
Training Command. 282 In order that combat crews maintain themselves at 
maximum efficiency it was necessary that they understand specifically the need 
for oxygen at altitude and the use of oxygen equipment, the characteristics of 
the oxygen system, its weaknesses, malfunctions frequently encountered, causes 
and prevention of oxygen casualties, oxygen emergency procedures. It was also 
necessary that they know how to cope with such factors as the effects of cold and 
general principles of clothing, frostbite, aero-otitis, aerosinusitis, gas pains, and 
bends. In addition, it was important that they understand emergency procedures 
and how to survive under emergency conditions. 283 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



211 



Although the development of the Altitude Training Program in the Army 
Air Forces had the benefit of Canadian, British, German, and other foreign 
training experience in aviation physiology, the field program necessarily 
developed along original lines. Since all pilot, bombardier, and navigatory 
aircrew trainees must pass through preflight schools, and all other aircrew 
trainees through flexible gunnery schools, these two types of installations were 
chosen for the establishment of the altitude training units. Moreover, since 
the exigencies of war would not permit profligate use of personnel and equip- 
ment, it was necessary to centralize training at large units rather than at all 
basic flying schools. This resulted in the establishment of three large units, 
each comprised of four 20-man chambers. These units were located at Max- 
well Field, Alabama, San Antonio Aviation Cadet Center (originally Kelly 
Field), San Antonio, Texas, and at Santa Ana Army Air Base, Santa Ana, 
California. In addition altitude training units, each comprised of two 20-man 
altitude chambers, were established at the following flexible gunnery schools: 

Tyndall Field, Florida 
Buckingham Field, Florida 
Harlingen AAF, Texas 
Laredo AAF, Texas 
Las Vegas AAF, Nevada 
Kingman AAF, Arizona 
Yuma AAF, Arizona 

Obvious advantages of the plan included the marked economy of personnel 
and equipment effected, the earlier and broader training of a maximum num- 
ber of aircrew trainees, the earlier discovery of selection factors related to 
tolerance of decompression, the minimum interference with actual flying train- 
ing, the maximum chance of a given type of station remaining in the same 
status, and, especially, the increased efficiency from several viewpoints resulting 
from the centralization of highly trained personnel and equipment. 

It is of interest to note that the actual birthplace of the Altitude Training 
Program in the AAF was Maxwell Field, Alabama. Here, during the latter 
part of 1941, and prior to the publication of any directive covering the program, 
instruction was begun even before altitude chambers were installed. The 
first altitude chamber arrived on 20 October 1941—48 days before Pearl Harbor. 

On 19 March 1942 AAF Headquarters established a directive pertaining 
to high-altitude indoctrination and classification. 284 This program was set 
forth in detail. There were two plans established, Plan "A" and Plan "B." Plan 
"A" specifically applied to aviation cadets at replacement centers and consisted 
of 4 hours of instruction (lectures on physiological principles of altitude 



212 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



flying oxygen) and i hour chamber flight to 28,000 feet. Plan "B" was similar 
in nature but of a more advanced character, consisting of 4 hours' instruction 
and a 4 ^4 -hour chamber flight to 35,000-40,000 feet. The functions of Plan "B" 
were to instruct and classify trained personnel assigned to tactical organizations 
with the Army Air Forces who had had no previous high-altitude indoctrina- 
tion, and to provide advanced instruction and additional classification of cadets 
in their basic training. Classification involved the qualification of flying per- 
sonnel in respect to whether they could endure high-altitude flights and what 
their limitations might be. 

At this early date the general plan for the program envisaged giving the 
elementary flight (Plan "A") in the preflight schools, and an advanced schedule 
(Plan "B") to trainees at basic schools, gunnery schools, and navigation schools, 
and to all other AAF flying personnel assigned to high-altitude operations. The 
original AAF Regulation 50-18 was supplemented by two succeeding editions, 
the second of which was issued 6 July 1943, and the third on 3 August 1944. 

These successive directives did not change the basic theory and practice 
of altitude training, but merely revised the policy relating to functions, super- 
vision, supplies, reports, and other problems which required certain modifica- 
tions as experience and new findings progressively altered objectives in this field 
of training. The two earliest AAF directives differed in that the one issued 
August 1942 required under Plan "B" a 3-hour flight above 38,000 feet, sup- 
plemented by a 45-minute flight afterwards to 24,000 feet for the purpose of 
demonstration of anoxia; whereas the earlier instructions issued in March 1942 
under Plan "B" required a 4-hour flight at 38,000 feet, and a few minutes at 
40,000 feet. The August directive also included allotments of grades and 
authorized strengths for Medical Department personnel with the Air Corps, 
which later proved to be totally inadequate for conducting such training. 

In December 1942 the Altitude Training Program was designated an Air 
Corps function, and altitude training units set up accordingly. The post surgeon 
was made responsible for the supervision of the program while aviation physi- 
ologists carried out the detailed execution of the program. 285 

By the summer of 1943 classification of flying personnel was deemphasized, 
the 3-hour flight at 38,000 feet eliminated, 286 and emphasis placed rather 
on the practical aspects of survival at high altitudes. 

Training procedures within the general structure of the Altitude Training 
Program consistently followed the definitive instructions outlined in the various 
AAF directives. In the AAF Training Command, altitude training units had 
by 1 November 1944 conducted approximately 42,000 separate chamber flights 
and trained a total of 622,894 different individuals in a total of 841,066 man flights. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



213 



Although training had of necessity been done on a mass assembly line basis, a 
careful observance of the methods employed disclosed the basic soundness 
of instruction. 

The purely didactic and theoretical aspects of the physiology of flight were 
usually given to fairly large number of aviation cadets or gunners in station 
theaters or large classrooms. These classes numbered from 180 to 240 indi- 
viduals. On the other hand, the definitive and practical training of these poten- 
tial aircrew members was conducted in small groups, never exceeding 20, 
within an altitude chamber where certain procedures amounted almost to a 
tutorial system. 

A logical accompaniment to the trend in training which resulted in 
deemphasizing classification of individuals was the placing of greater em- 
phasis on practical training in the use of oxygen and individual protective equip- 
ment at simulated high altitudes. The central idea of training now became 
participation in the various maneuvers actually encountered by flying personnel 
during flight. Trainees were required to think out emergency situations and 
execute remedial action during altitude chamber flights. The liberal attitude 
toward training functions exemplified in AAF directives encouraged the altitude 
training units to develop their definite training procedures. 

Although the Army Air Forces Training Command was required to train 
aircrew personnel from a number of foreign countries, including Brazil, 
Bolivia, Chile, Mexico, and Venezuela, the most difficult programs conducted 
were those developed for the Chinese and French Nationals. At Santa Ana 
Army Air Base the contents of an AAF Technical Order, "Your Body in 
Flight," including the illustrations, was translated in its entirety into the 
Chinese language. The personnel at Santa Ana who accomplished this feat 
had the cooperation of the Chinese Air Force liaison officer, as well as a few 
students of the Chinese language available in the unit. A similar project was 
developed at Maxwell Field where the French trainee underwent altitude 
indoctrination. There, too, technical data were translated into the French lan- 
guage and all indoctrination was conducted in French, assisted by an altitude 
chamber technician assigned to the unit who spoke French fluently and worked 
closely with the French liaison instructors from fields within the Eastern Flying 
Training Command. To the discriminating observer, the effectiveness of these 
programs for foreign nationals was highly significant and indicated the sound- 
ness of the basic indoctrination policy and procedures. 

Other phases of the program in the AFTRC included a water-survival 
training program conducted in collaboration with the physical training de- 
partments at Santa Ana (formerly), and at San Antonio Aviation Cadet Center. 



214 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

During this instruction all available water-survival and personal-protective 
equipment was actually demonstrated in the swimming pools. Not only pre- 
flight aviation cadets, but also officer candidate school students, permanent 
party officer personnel, and certain individuals in the Convalescent Training 
Program participated in the water survival demonstrations. Units also devoted 
an hour or more to instruction in night visual ability. 287 

Altitude training activities in the four air forces appears to have been little 
different from those in the Training Command. Chronologically they 
paralleled activities in that command. In the Second Air Force, for example, 
attempts were made as early as November 194 1 to get an Altitude Training Pro- 
gram underway, 288 but not until nearly a year later did plans develop. On 
13 April 1943 nine units were created in the Second Air Force by War Depart- 
ment directive. Twelve chambers were furnished the Second Air Force for 
equipping the units, eight being small and four large. In addition to fulfilling 
its primary training mission, the Altitude Training Department of the Second 
Air Force worked with the flight surgeon in the evaluation of flying personnel 
through the use of the low-pressure chamber. Men complaining of difficulty 
while flying were studied in the chamber to ascertain whether or not the diffi- 
culty arose from lowered barometric pressure or from some other cause. The 
low-pressure chamber indoctrination was also given in this department to 
those crew members who missed the flight at previous stations. As a corollary 
of the medical phase of its mission, the Altitude Training Department worked 
on altitude research problems commensurate with its limited equipment. 

The increasing emphasis on personal-equipment training and maintenance 
expanded the importance of the Altitude Training Section. The history of this 
transition at one station in the Second Air Force (Ardmore, Oklahoma) was 
typical of the other units. When the 3d Altitude Training Unit was inacti- 
vated, its personnel were transferred in a body to the Altitude Training Section. 
Later, when the director of the Altitude Training Section was given the addi- 
tional duty of station personal equipment officer, the entire organization be- 
came the Personal Equipment Section, at the same time retaining its identity 
as the Altitude Training Section. A single body of men, therefore, functioned 
as a personal equipment section and an altitude training section. Although 
the two sections had identical personnel, they were still treated as separate enti- 
ties for administrative purposes. Courses in personal equipment included 6 
hours of lectures, demonstrations and tests given to all copilots to fit them to 
assume the duties of personal equipment officers for their respective crews. The 
course included the construction of a simple oxygen system by the students 
themselves, the servicing of oxygen supply, the construction of oxygen regula- 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



215 



tors (actual disassembly by the class), fire extinguishers, the storage of life rafts 
(demonstration of inflation), flak suits, emergency sustenance kits, and 
parachutes including preflight use (particularly in combat), bail-out drill pro- 
cedure, and overwater bail-out procedure. Six hours were devoted to ditching 
instructions. 

Similar training activities were under way by 1942 and 1943 in the other 
three air forces. In the First Air Force an Altitude Training Unit was estab- 
lished at Mitchel Field in December 1942, soon after the formal inauguration 
of the Altitude Training Program in the AAF earlier that month. Eventually 
the number of units grew from the original one to a total of seven in the First 
Air Force. 289 In the Third Air Force activities were under way by January 1943, 
at which time six units were ready for operation. An indication of the amount 
of training carried on is shown by the fact that 46,165 personnel were given 
altitude training at the seven altitude training units in the Third Air Force in 

1944. 290 

Altitude training in the Fourth Air Force was characterized by the fact 
that the geographic location afforded a natural laboratory for the study of 
flying conditions. The west coast had high-altitude air strips, mountains over 
14,000 feet in height, desert areas, fog belts and a long coastline for overwater 
flights. Following much the same pattern as that in the First, Second, and Third 
Air Forces, the Fourth Air Force program simply extended the training received 
at the Training Command. In May 1943 the IV Bomber Command stand- 
ardized training in altitude flying and effect on crews to include an introduc- 
tion to altitude flying, characteristics of the earth's atmosphere, oxygen, effects 
of low pressure, aero-embolism, gastro-intestinal cramping, sinus pain, aero- 
otitis media, effects of cold, methods of maintaining proper body heat balance, 
physiological effects of cold, and psychological effect of cold. This was the first 
attempt at standardization of medical training for altitude indoctrination both 
as to type and as to training material covered. The first medical training pro- 
gram for heavy bombardment crews appeared in late May 1944. 291 Thirteen 
hours were allotted for medical training with certain modifications being made 
along the way. In October 1944 the program was standardized to produce a uni- 
form progressive course of instruction, 292 and this medical training program was 
incorporated within the over-all training program. 

In a similar fashion the medical training program for fighter pilot trainees 
was revised, and described in Fourth Air Force Memorandum 53-20, dated 
3 October 1944, which coordinated the medical training program with the 
over-all fighter training program. Fourth Air Force Memorandum 54-20, 
22 December 1944, set forth the medical training in complete outline form and 



216 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



also provided an individual check list to prevent duplication of training in the 
event of transfer from one station to another. Seventeen hours of instruction 
were allotted for medical training, and the material covered was essentially as 
noted above for the heavy bombardment crews with the exception of some 
modifications necessitated by the coordination with the over-all program. 293 

The effectiveness of the altitude training program could, of course, be 
judged only after it had been tested in combat. A survey of 1,485 combat 
flying personnel made by the AAF School of Aviation Medicine 294 warranted 
certain conclusions. The altitude training program in comparison with 
other ground training programs was given a rating of average by 53.9 percent 
of combat returnee flying personnel, better than average by 41.8 percent, and 
poorer by 4.3 percent. It was found that "Training Aids" received the best 
comparative rating, with "Lectures" running second and "Preparation for 
Combat" the poorest. The program improved progressively from the first 
half of 1943 through 1945. About 93 percent stated that no part of the war- 
time altitude training program was a waste of time. The demonstration of 
oxygen equipment was commended. The most common omission (6.9 per- 
cent) was in the teaching of emergency procedures. Two-thirds of those 
who had used oxygen or operational altitude missions believed they had been 
given insufficient altitude training for combat. Twenty-three percent of those 
interrogated stressed the need for increased emphasis on the teaching of emer- 
gency oxygen procedures. In-flight altitude training was requested by 71.8 
percent. There was, it should be noted, little difference in the opinions of 
B-17 crews, B-24 crews and fighter pilots. 295 

A summary of indoctrination flights, and flights for research purposes in 
all altitude chambers follows: 296 



Table 15.— Altitude-Chamber Flights 



From — 



1 Feb. 1942. . 
30 June 1942. 
30 June 1943. 
30 June 1944. 



Total . 



To— 



30 June 1942. 
30 June 1943. 
30 June 1944. 
30 June 1945. 



Number 
individuals 
indoctrinated 



1, 340 
6,316 
8, 191 
3, 921 

19, 768 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



217 



In May 1942, meanwhile, certain standards for physical condition, educa- 
tion and mental qualifications had been suggested for enlisted personnel se- 
lected to operate altitude-chambers since members of the chamber crews were 
subjected to long and frequent exposures to high altitudes. 297 The Chief of 
the Physiology Department, School of Aviation Medicine, stated that because 
of the uncertainty concerning the pathological effects of long exposures, con- 
tinued flights beyond a total of 150 to 200 hours were not desirable, and recom- 
mended that a policy of rotating personnel be inaugurated. 298 The inauguration 
of such a genera] rotation policy was opposed by the Office of the Air Surgeon 
because of the difficulty of securing suitable men for this duty and because 
inspections and examinations did not show prevalence of deleterious effects 
on operators. 299 The Commandant recommended in July 1944 that certain 
of these enlisted men be transferred, without prejudice, to assignments other 
than duties in the altitude chamber. 300 

By October 1944 the development of certain incapacities in personnel 
required to perform duties in altitude chambers emphasized the need for more 
discriminating physical examination of personnel assigned to duty with these 
units. Studies of disabilities of military personnel engaged in the altitude 
program had revealed cases of tuberculosis, psychosis and cardiovascular dis- 
eases. The fact that such disabilities were incident to this type of work was 
neither proved nor disproved. 301 The School was directed to make suggestions 
as to an examination that would result in a basic level for comparison with 
future examinations. A detailed physical examination including laboratory 
test, to be given every 6 months, was outlined and forwarded to the Air 
Surgeon. The proposed special "Research Examination" for individuals to 
be continuously studied as to the effects of altitude was not considered prac- 
tical unless given by a team of expert examiners. 302 In July 1945 it was sug- 
gested by the School that if the technicians in the AAF Altitude Training 
Program could be sent to the School for a careful examination prior (during 
training) and after the period of service, more definite information might be 
available on this problem. 303 

With the reduction of teaching activities of the altitude training units it 
became possible to undertake research in addition to teaching. It was planned 
that the School might act as a coordinating agency in fostering research proj- 
ects in various units. No specific plan to accomplish this purpose was approved 
but the facilities of the School were always available for consultation and 
reference. 304 



218 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

Air-Sea Rescue Training 

On 3 March 1944, following a visit by the Surgeon, AAF Flying Training 
Command, a syllabus was drawn up for the medical training of the air and 
ground crew members, including the surgical technicians being assembled 
for the Third Emergency Rescue Squadron. This training was carried out by 
three medical officers assigned to the 26th Technical School Group. The 
syllabus, drawn up in accordance with War Department directives, 305 provided 
for a 6-week course of 1 hour daily in first-aid, sanitation, and personal ad- 
justment to all members of the squadron, approximately 250 air and ground 
crew personnel. The classroom instruction of the crew members was supple- 
mented by instruction on practical rescue missions through the services of the 
five medical officers assigned to the squadron. 306 On 7 April 1944 the Provisional 
Army Air Forces Emergency Rescue School (which included the former 1007th 
Quartermaster Rescue Boat Operational Training Unit — Aviation) moved 
from Gulfport Field to Keesler Field and became the 2121st Army Air Forces 
Base Unit (Emergency Rescue School). 

The training of surgical technicians for the Marine Section of the Emer- 
gency Rescue School was undertaken, on 3 May 1944, in addition to training 
those assigned to the Fourth Emergency Rescue Squadron. Previously, the sur- 
gical technicians for the boat crews had been trained by medical personnel of 
the Station Hospital, Gulfport Field, with on-the-job training in the hospital. 
Subsequent interviews with these technicians demonstrated the inadequacy of 
this type of training. In May 1944 the syllabus of instruction was revised. Until 
then the incoming students had received some instruction in first-aid and sani- 
tation. However, the small amount of time allotted to medical training in the 
6-week air schedule required that the number of hours devoted to first-aid, 
sanitation, and personal adjustment be reduced to 13 hours. This was in 
accordance with the directive for operational training units in Army Air 
Forces Letter No. 50-16. 307 

Surgical technicians in the Marine Section of the Emergency Rescue School 
received their training as technicians at Keesler Field during their 12-week 
period of individual training and training in seamanship was given at Gulfport 
Field. Following completion of the individual training phase, they were 
assigned to marine crews for further operational training as crew members. 

Because of the unavailability of low-pressure chambers, members of the 
Third Emergency Rescue Squadron were given 3 hours of altitude indoc- 
trination in accordance with AAF Training Standard No. 1 10-291, and Train- 
ing Command Memorandum No. 50-0-3, 308 but without the necessary chamber 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



219 



flight. When the low-pressure chamber at Gulfport Army Air Field, Gulfport, 
Mississippi, became available to the crews of the Emergency Rescue School on 
27 June I944, 309 full altitude indoctrination instruction was given to members 
of the Fourth Emergency Rescue Squadron and to the subsequent replacement 
crews trained at this school. This instruction conformed with Army Air Forces 
Letter No. 50-28. 310 

Meantime, a flight surgeon's office was established for the supervision of 
flying personnel and the centralization of records of physically qualified per- 
sonnel. With the activation of the Second, Third, and Fourth Emergency 
Rescue Squadrons, a flight surgeon and four aviation medical examiners were 
assigned to each squadron. The senior flight surgeon of the Emergency Rescue 
School supervised the activities of the squadron flight surgeons, and cared for 
the pilots in the school. The flight surgeon and the Director of Medical Train- 
ing, both rated flight surgeons, spent considerable time in instructing aircrew 
personnel while aloft, on combined practice flight problems in conjunction with 
the Marine Section of the School. With the activities of the Emergency Rescue 
School the unit surgeon was instructed to establish all medical facilities for the 
unit except for hospitalization. 311 Cadres trained at this school were sent to 
various air-rescue activities. 312 

Medical Service Training School 

The medical training for nonmedical units pursued by the Air Technical 
Service Command (ATSC), largely involved individual training in first-aid, 
sanitation, and personal adjustment problems. Nonmedical units were organ- 
izations which became, near the end of their training, an integral part of an air 
depot group or an air service group. Thus the various medical training require- 
ments, such as standing operating procedures, formation and training of anti- 
malarial details, and preparation of the unit became the responsibility of the 
medical section of the group to which the nonmedical unit was assigned. 

At Headquarters, Air Service Command, such medical training for tactical 
service proved unsatisfactory. There was no established system of logistics 
whereby students could be moved to and from the school and, consequently, 
could not be furnished to air service tactical units at the proper time. It was 
often necessary to furnish large numbers of trained personnel to the Army Air 
Forces, requirements for which had not been established, thus breaking up the 
previously planned medical sections as a source for personnel. And, finally, 
the commitments and requirements for Air Service Command tactical units 
changed so quickly from time to time that a system of logistics and control could 
not possibly have been established on a workable basis. 313 

262287°— 55 16 



220 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

The Surgeon, Air Service Command, recognizing this situation when he 
reported for duty in July 1942, suggested that the Surgeon, Warner Robins Air 
Depot Control Area Command, Georgia, formulate plans for building a med- 
ical training installation primarily for training and forming medical sections 
for Air Service Command tactical units. This was done and in September 1942 
the Headquarters, ASC School, opened at Robins Field under title of Medical 
Training Section, Air Service Command. It was 14 months until the 
War Department finally authorized the establishment of an AAF School under 
the title of AAF Medical Training School. 314 

The first students in these medical sections were medical officers who were 
reporting almost daily for duty in the Air Service Command. Assigned first 
to the School at Robins Field, they would later be utilized in tactical units or 
at fixed installations, depending upon the requirements at the time of their 
graduation. Enlisted personnel for training were obtained from three sources: 
directly from Army Air Forces, from Air Service Command Station Hospitals, 
and from personnel sent on detached service to ASF schools from the Air 
Service Command. 315 The first units were more or less aggregations of in- 
dividuals brought together without much training and designated as medical 
supply platoons, aviation. 

When the Medical Training Section, Air Service Command, became firmly 
established, these units were trained in a much better manner. One basic 
weakness remained, however. The training period was for a period of 6 
months, the same as that of an air depot group, but since this small organization 
usually had received all of its training within the first 2 months, in the subse- 
quent months of waiting, the organization would disintegrate along with morale 
and efficiency. Not until late fall 1944 was authority granted to reduce the 
length of the training period from 6 to 2 months. Later there was no com- 
bined training period for medical supply platoons, aviation, and the training of 
these units consisted simply of 1 month's unit training under jurisdiction 
of the 4520th AAF Base Unit, utilizing the facilities of the ASF Medical Supply 
Depot, Savannah, Georgia, with one month of orientation training in an air 
depot group type of assignment. 

Meanwhile, the lack of over-all logistical planning proved a serious problem 
in training activities as well as in actual procurement and assignment of per- 
sonnel. This became apparent as early as December 1942, at which time there 
were some 80 medical officers who had been through the course at the 
school once and virtually completed the same course for the second time. In 
this group there were officers who had been to the Medical Field Service 
Training School, Carlisle Barracks, Pennsylvania, had been sent to duty at 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



221 



some Air Service Command hospital, ordered to the school at Robins Field, 
and then, through some mistake, sent back to the Medical Service Training 
School, and were at the time present in the Medical Officers' Course at Robins 
Field for the second time. With the establishment of the AAF Medical Service 
Training School in 1943, however, the responsibility for training medical sec- 
tions for tactical units was finally centered in one headquarters. Together with 
the facilities already available through the Air Service Command Medical 
Detachment at Robins Field it was possible at last to train personnel necessary 
for medical dispensaries, aviation; to train casual personnel for direct shipment 
overseas, both for Army Air Forces and Air Technical Service Command pur- 
poses; and to train medical sections for ATSC tactical units. The school 
operated itself as directed by headquarters, but remained for reporting purposes 
under the administrative jurisdiction of the Air Service Command. 316 

During the period between September 1942 and September 1943, the train- 
ing program included training for both officers and enlisted men. The 
4-week officers' course included basic, tactical, and technical subjects designed 
to prepare civilian doctors and dentists for duty with Air Service Command 
tactical organizations. 317 Enlisted training was first accomplished by the staff 
of each provisional company organized to quarter, ration, and train enlisted 
personnel. In order to organize personnel for continuous and progressive train- 
ing, certain companies were designated to conduct specific types of training — 
i. e., basic, technical, tactical, and unit. All training was scheduled week by 
week and was continuously progressive for any group of enlisted men. 318 

From March 1943 to September 1943 enlisted training took precedence 
over all other types of training. During this period the training course, later 
known as the "AAF Medical Service Training School Field Training Course," 
was evolved and consisted of a definite period of technical adaptation in specific 
MOS schools, common basic, tactical, and technical medical instruction for 
all specialists, together with bivouacs for practical application of knowledge 
previously gained. Courses varied in length, depending upon instructions 
from higher authority and departure dates for students. Statistically, during 
the official life of the Air Service Command Medical Training Section, 4,669 
enlisted men, 992 Medical Department officers, and personnel of 45 Medical 
Supply Platoons (Aviation) received training of variable type and for variable 
periods. 

On 1 November 1943 the Air Service Command Medical Training Section 
became the AAF Medical Service Training School 319 and functioned under 



222 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



the control of the Commanding General, Army Air Forces, with trained 
personnel to staff the school being provided by the Commanding General, Air 
Service Command. 320 

The first cycle of the Field Training Course and the Officers' Field Train- 
ing Course started on 13 December 1943 and terminated 22 January 1944. 
With the conclusion of the cycle, it became evident that one training course 
for enlisted personnel would not cover the training responsibilities of the new 
school because all casual personnel were not immediately required for projects, 
nor were all medical dispensaries (aviation) and medical supply platoons 
(aviation) called for overseas duty directly upon completion of this 6-week 
course. Accordingly, an Advanced Training Course for casual personnel and 
a Unit Training Course for medical dispensaries (aviation) and medical 
supply platoons (aviation) were developed. By March 1944 Air Service 
Command began ordering enlisted personnel assigned to the Air Service Com- 
mand Medical Training Detachment to Robins Field. This personnel arrived 
so irregularly and often in such large numbers that a fourth training course for 
enlisted personnel had to be developed to keep these men engaged until the 
beginning of a new cycle of the Field Training Course. This training course 
was designated as a Holding Course. Thus, throughout 1944, five different 
types of training courses were designed and accomplished by the Training 
Department of the Medical Service Training School: the Field Training 
Course, the Officers' Training Course, the Advanced Training Course, the Unit 
Training Course and the Holding Course. 

NOTES TO CHAPTER III 

1 This chapter is a condensed and consolidated version of manuscript histories prepared during World 
War II by the SAM, the Commands and Con AFs and the special training schools. 

* Commandants of the School of Aviation Medicine through the World War II period were as follows: 
Maj. L. H. Bauer, Director, Medical Research Laboratory at the School for Flight Surgeons, January 

1919-25. 

Maj. Francis H. Poole, MC, December 1926— August 1930. 

Maj. Benjamin B. Warriner, MC, September 1930-September 1932. 

Lt. Col. Albert P. Clarke, MC, September 1932-November 1933. 

Col. Arnold D. Tuttle, MC, May 1 93 4— November 1937. 

Col. Coleridge L. Beaven, MC, November 1937-February 1939. 

Lt. Col. Fabian L. Pratt, MC, March 1939-September 1941. 
In September 194 1, Col. Eugen Reinartz was appointed Commandant, a position he held throughout the 
war period until his retirement in July 1946. Replacing him at that time was Col. Harry G. Armstrong 
who, after his return as surgeon, Eighth Air Force, had served as Director of Medical Research at the School 
and who later was to become the second USAF Surgeon General. 

3 H. L. Bauer, Address, "The School of Aviation Medicine," Journal of Aviation Medicine, III (Dec. 
1932), p. 212. 

* A. E. Truby, and John Dibble, "Operations of the Medical Division of the Air Service," The Military 
Surgeon, XL VII (July 1920), p. 67. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



223 



Ibid, 

9 Proposed AR 350-105, WD, Wash., D. C, 8 Nov 22. 

7 Annual Rpt, 1921, p. 2. 

8 Memo for Lt. Col. Taylor from Maj. L. H. Bauer, 18 Jun 25. 

9 Reply to and on ltr., Dr. H. A. Coleman, TAS to Dr. I. H. Jon^s, Los Angeles, Calif., 25 Nov 44. 
"Annual Rpt, 1920, p. 10. 

11 AR 350-105, WD, Wash., D. C, 18 Nov 22. 

12 Annual Rpt, 1 921, p. 9. See also Rpt, Capt. Thome to Comdt., SAM, 20 Sept 27. 
18 Annual Rpt, 1921, p. 23, and 1923-24, p. 4. 

14 Ltr., Comdt, SAM, to C/ Med Sev, OCAS, Wash., D. C, 21 Jul 24. 
u Annual Rpt, 1921, p. 4. 
" Ibid, p. 25. 

17 Ibid. 

18 Ibid., p. 26, and 1924, p. 24. 
"Annual Rpt, 1921, p. 28. 

20 See AFTAS files for Roster of Graduates. 

21 Annual Rpt, 1924, p. 35. 

22 See n. 8. 

23 Annual Rpt, 1924, p. 2. 

24 Annual Rpt, 1920, pp. 47-48. 

28 Book of Graduates, Flight Surgeons. 
"Annual Rpt, 1923-27, pp. 1-3. 

27 See n. 25. 

28 Book of Graduates, Board Proceedings 1921-26. 
"Annual Rpt, 1921, p. 38. 

*° Memo for Exec. Off., SGO, from Maj. L. H. Bauer, SAM, 14 Nov 25. 

81 See n. 19. 

82 Memo for TSG from AC/S, Wash., D. C, 15 Oct 23. 

88 4th Ind. (basic Memo for TSG from AC/S, Wash., D. C, 15 Oct 23), AGO, Wash., D. C, to C/Atr 
Service, 7 Oct 23. 

a *H. L. Bauer, Instruction of the Reserve and National Guard Officers, 1923, pp. 1-8. 
88 Ibid. 

38 Annual Rpt, 1924, p. 9. 

37 Book of Graduates, 609 Examiners. 

88 2d Ind. (basic ltr., W. F. Smith to Comdt., SAM, 15 Sept 42), AS, OCAC, to Comdt., SAM, 29 Oct 42. 

38 Bauer, op. cit., pp. 1-7. 

40 See n. 6. 

41 Annual Rpt, 1924, p. 11. 

Ltr., Comdt., SAM to C/Med Serv., Air Serv., 1 Sept 22. 
48 Memo for CG, ACTC, Duncan Fid, Tex., from Comdt., SAM, 4 Nov 26. 
44 Annual Rpt, 1928, p. 20. 

48 Ltr., Comdt., SAM to C/ AC, through: CG, ACTC, 21 Apr 27. 

" AR 350-580, 30 Dec 26, AR 350-570, 31 Oct 40, WD, Wash., D. C. 

47 Memo for Comdt., SAM from TAG, 19 Sept 27. 

48 Ltr., TAG to CG, AC, 27 Sept 27. 

49 Rpt, Comdt., SAM, to TAG, 1939. 
60 Annual Rpt, 1928, p. 2. 

51 Annual Rpt, 1 929, Recommendations. 

M ACTC Diary, 1 Oct 31, Auth Library, Hq, AAFCFTC, Randolph Fid, Tex. 

83 Ltr., C/AC to TAG, Wash., D. C, 12 Jun 31. 
64 Annual Rpt, 193 1, p. 15 and 1932, p. 1. 

55 Ltr., TAG to Comdt, SAM, 10 Dec 31. 
66 AR 350-500, WD, Wash., D. C, 1 Oct 32. 
87 Annual Rpt, 1932, p. 6. 



224 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



88 Annual Rpt, 1933* P- 5> ano " I 934> P- 6- 

69 Ltr., C/AC to TAG, Wash., D. C, 7 Sept 43- 
60 Annual Rpt, 1936, p. 6. 

81 3rd Ind. (basic ltr., Comdt., SAM, to TAG, 21 Dec 39), TSG to C/AC, 7 Oct 39. 
02 Ltr,, C/Med. Div., OCAC, to Comdt., SAM, 9 May 39. 

83 Ltr., C/AC, Hq., WD, Wash., D. C, to TAG, Hq., WD, Wash., D. C, 21 Dec 39. 

84 Ltr., Maj. Gen. H. H. Arnold, C/AC to TAG, through: TSG, 27 May 40. 
88 Ibid. 

96 See n. 62. 

"Schedules, AAFSAM, AME, 1939-40. 

88 Annual Rpt, AAFSAM, 1941, p. 26. 

99 Ltr., Comdt., AAFSAM, to CMC, 3 Apr 41. 

70 Ltr., C/Med. Div, OCAC, to Comdt., AAFSAM, through: CG, ACTC, Randolph Fid, Tex., 4 Jun 41. 
Tl Memo for Comdt., AAFSAM, from Dir, Research, AAFSAM, 28 Nov 41. 

78 Ltr., Surg, ACAFS, Kelly Fid, Tex., to Comdt., AAFSAM, 9 Dec 41. Ltr., Surg, ACTC, Moffett 
Fid, Calif., to Comdt., AAFSAM, 9 Dec 41. Ltr., Surg, SEACTC, Maxwell Fid, Ala., to Comdt., AAFSAM, 
15 Dec 41. 

73 Ltr., AAG Hq., AAF, to AG 3 through: TSG, 11 Feb 42. 
"Annual Rpt, 1943, p. 5. 
75 Ibid. 

,B Rpt, Annual General Inspection of the AAF Basic Flying School, Randolph Fid, Tex., 17 Sept 42. 
n 1st Ind. (basic Rpt Annual Inspection, 17 Sep 42), Comdt., AAFSAM to CG, GCFTC, Randolph Fid, 
Tex., 22 Sep 42. 

78 See n. 74. 

79 Ltr., TAS, Hq. AAF Wash., D. C, to the Surg, AAFFTC, Fort Worth, Tex., 8 Sept 42. 

89 E. G. Reinartz, "The School of Aviation Medicine and the War," pp. 6-7. 

81 Rpt, Committee on Classification Centers, Sep 42. 

82 Ltr., Surg, Nashville Army Air Center, Nashville, Tenn., to Comdt., AAFSAM, 13 Apr 43. 
88 Hist, of the San Antonio Branch of the SAM SAACC,Tex„ 1942-43* P- 

84 Program, Practical Course in Administration, 1942, Station Hospital, Kelly Fid, Tex. 
88 See n. 83. 
88 See n. 83. 

87 See n. 83. 

88 AAF Regulation No. 50-17, 14 Oct 1943, rescinded AAF Reg. No. 50-1 7, 30 Oct 42. 
" See n. 83. 

90 Ltr., Exec Off, Aircrew Physical Processing Unit, Santa Ana Army Air Base, Santa Ana, Calif., to 
Comdt., AAFSAM, 23 Nov 43. 

" Ltr., Comdt, ASBS, Santa Ana, Calif., to TAS, Hq., AAF, Wash., D. C, 27 Apr 43. 
92 See n. 90. 

98 Ltr., Surg. SEAAFTC, Maxwell Fid, Montgomery, Ala., to Comdt., SAM, 14 May 42. 
94 Hist, of Med. Activities, SEAAFTC, Maxwell Fid, Ala., Vol. I, Sec. II. 
"Ltr., Surg., SEAAFTC, Nashville, Tenn., to Comdt., AAFSAM, 14 Aug 42. 
98 Memo for Comdt., AAFSAM, from Actg. AS, Hq. AAF, Wash., D. C, 4 Dec 42. 

97 Ltr., Surg., NAAC, Nashville, Tenn., to AS Hq, AAF, Wash., D. C, 22 Apr 43. 

98 Med. Hist., AAFETC, Vol. II, p. 152. 

"Hist, of Med. Activities, AAF Eastern Flying Training Command, Maxwell Fid, Ala., Vol. I, Sec. II. 
100 Annual Rpt, AAFSAM, 1943, p. 38. 

m Ltr., Exec. OfT., Off. of TAS, Hq AAF, Wash., D. C, to Operations, Off. of TAS, 28 Jun 43. 
181 Annual Rpt, AAFSAM, 1944, p. 14. 

103 Ltr., TAS, Hq, AAF, Wash., D. C, to CG, AAF SAT, Orlando, Fla., 8 Jul 44. 

104 Ltr., TAS, Hq. AAF, Wash., D. C, to Comdt., AAFSAM, 1 1 Apr 44. 
,w Ltr., Comdt., AAFSAM, to CG, AAF, Off, of TAS, 21 Jan 44. 

108 Ltr,, Asst. C/AS Training, Hq, AAF, Wash., D. C, to CG, AAFTC, Fort Worth, Tex., 21 Jul 44. 
197 Ltr., TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 27 Jul 44. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



225 



xw Ltr., TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 29 Aug 44. 

1W Interview, Asst. Dir/Training, AAFSAM by Hist. Off., AAFSAM, 14 May 45. 

110 Memo for Comdt., AAFSAM, to Dir/Training, AAFSAM, 30 Oct 44. 

111 1st Ind. (basic ltr., CO, Randolph Fid, Tex., to Comdt., AAFSAM, 28 Sep 44), CG, AAFSAM, to 
CO, Randolph Fid, Tex., 6 Oct 44. 

112 Program, AAFSAM, AME, 24 Sep-24 Nov 45. 

113 Ibid., 10 Dec 45-28 Feb 46. 

114 Ibid., 2 Jul 45-15 Sep 45. 

115 Ibid., 13 Jan-Mar 44. 

116 Ltr., Col. M. C. Grow, III AF, Tampa, Fla., to Comdt., AAFSAM, 19 Jun 42. 

117 Ltr., Comdt., AAFSAM, to Capt. N. A. Robinson, Scott Fid, 111., 13 Mar 42. 

1M C. E. Kossmann, The Heart in Relation to Aviation, Transcript of 4th Service Comd. Conference, 
19-21 Nov 42, pp. 2-7. 

xw Ltr., Surg., SEACTC, Maxwell Fid, Ala., to Comdt, AAFSAM, 15 Dec 41. 

120 1st Ind. (basic ltr., Comdt., AAFSAM, to AG through: channels, 10 Dec 41) TAS Hq., AAF, to 
Comdt., AAFSAM, 29 Dec 41. 

121 Annual Rpt, AAFSAM, 1942, p. 9- 

122 Ibid., 1943* PP- 8-9- 

123 Ibid., 1944, p. 28. 

124 1st Ind. (basic ltr., TAS, to Comdt., AAFSAM, 16 Oct 44) Comdt., AAFSAM to CG, AAF, Off. of 
TAS, 24 Oct 44. 

120 Interview, Maj. Jan H. Tillisch, Dept. of Medicine, AAFSAM, by Hist. Ofr., AAFSAM, 23 Oct 45. 

™ GO No. 7, AAFSAM, 22 Sept 44. 

12T Program, AAFSAM, AME, 9 Apr-23 June 45. 

128 Annual Rpt, AAFSAM, 1944, p. 21. 

129 Rpt, Surg. Training, AAFSAM, Maj. E. C. White, AAFSAM, to Lt. Col. R. L. Clark, C/Dept. of 
Surgery, AAFSAM, 25 May 46. 

130 In 1944, Capt. E. C. White, Dept. of Surgery, Acted as Technical Advisor to the AAF 1st Motion 
Picture Unit in the production of a training film entitled, "The Removal of Combat Casualties from Aircraft." 
This film was used in subsequent classes as a training aid. 

"'Programs, AAFSAM, AME, 1938-46. 

132 Ibid., May-Jul 46. 

133 While the Department of Aviation Medicine was responsible for the instruction in physiology and 
oxygen indoctrination until April 1945, the actual instruction was given by the staff of the Research Section, 
Department of Physiology. 

134 Program, AAFSAM, AME, 1942-44- 

13a Memo for Comdt., AAFSAM, from Asst. Comdt., AAFSAM, 29 Oct 43. 

138 Annual Rpt, AAFSAM, 1944, p. 23. 

Ltr., Plans & Training Off., Fid. Exercises, AAFSAM, C Dept. of Mil. Med., AAFSAM, 1 Oct 43. 
M8 Ltr., Asst. Comdt., AAFSAM to Comdt., AAFSAM, 30 Sept 43. 

139 Program, AAFSAM, AME, 12 Jul-7 Oct 43, 26 Aug-27 Oct 43. 

14U Ltr., C/Prevcntive Med., Off. of TAS, to Comdt., AAFSAM, 13 Apr 44. 
141 Ltr., Comdt., AAFSAM to CG, AAF, Off. of TAS, 20 Apr 44- 

142 1st Ind. (basic ltr., Exec. Research Div., Off. of TAS, to Comdt., AAFSAM, 3 Jun 44) Comdt., 
AAFSAM, to CG, AAF, Off. of TAS, 17 Jun 44. 

143 Program, AAFSAM, AME, 5 Jan-28 Mar 42. 

144 Annual Rpt, AAFSAM, 1942, pp. 6-7. 
146 Annual Rpt, AAFSAM, 1944, p. 28. 

146 M. J. Reeh, F. V. Heagen, and E. W. Stimmel, A Motor Driven Ophthalmotrope, AAFSAM Project 
No. 466, 20 Feb 46. 

147 Annual Rpt, AAFSAM, 1942, p. 10. 
lw Ibid., i943> P- 7- 

149 1st Ind. (basic ltr., TAS to Comdt., AAFSAM, 29 Mar 44), Comdt., AAFSAM, to TAS, Hq., AAF, 
Wash., D. C, 19 Apr 44. 



226 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



w Program, AAFSAM, AME, Jul 44-Jun 45- 
a " Ibid, 

M8 Annual Rpt, AAFSAM, 1944* PP« 38-39* 

188 C. M. Kos and H. D. Smith, Aviation Otolaryngology, AAFSAM Project No. 303, Rpt No. 1, 
16 Aug 45. 

M4 Interview, Lt. Col. Robert C. Anderson, Dept. of Neuropsychiatry, by Hist. Off., AAFSAM, 23 Oct 45. 
""Program, AAFSAM, AME, 6 Apr-16 May 42. 

" 8 R. C. Anderson, Psychiatric Training of Medical Officers in the AAF, Jan 46, prepared for the 
History of Psychiatry in the AAF. 

" T E. G. Reinartz, Effect of Flight on Man, p. 7, 30 Oct 43. 
188 See n. 80. 

1W Program, AAFSAM, AME, 12 Jul-7 Oct 43. 

180 See n. 156. 

181 Ibid. 
™Ibid. 

168 See n. 147. 

164 Annual Rpt, AAFSAM, 1944, pp. 35-36. 

185 Ibid., 1942-43, pp. 8-10, 
16fl See n. 164. 

167 See n. 156. 

188 See n. 167. 

189 See n. 164. 

1T0 R. C. Anderson and Associates, Outline of Neuropsychiatry, AAFSAM. 

171 See n. 164. 

172 Rpt, AAFSAM, Med. Officers to Comdt., AAFSAM, 28 Jan 42. 
in Ibid. 

174 See n. 172. 

m Annual Rpt, AAFSAM, 1941, p. 26. 
178 Ibid., 1942* p. 19. 

177 Rpt, Student Failures, 1942, pp. 1-4. 

178 Rpt, Student Qualifications, AAFSAM, 1942. 

179 See n. 177. 

180 1st Ind. (basic ltr., Surg., WCAAFTC, to Comdt., AAFSAM, 5 Aug 42), Comdt., AAFSAM, to 
Surg. WCAAFTC, Santa Ana, Calif., 10 Aug 42. 

181 Annual Rpt, AAFSAM, 1943, p. 6. 

182 Ltr., Actg, TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 12 Apr 44. 
188 Ltr., TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 17 Mar 42. 

184 1st Ind. (basic ltr., Surg. TAFS, to Comdt., AAFSAM, 23 Jul 42), Comdt., AAFSAM, to Surg. 
TAFS, Tuskegee, Ala., 20 Aug 42. 

186 Ltr., C/AS, Hq., Wash., D. C, to TAS, AAF, Wash., D. C, 1 1 Jan 43. 
188 Ibid. 

™ Ltr., Comdt., AAFSAM to Comdt., NAAC, Nashville, Tenn., 10 Mar 43. 
188 Annual Rpt, AAFSAM, 1942, p. 4. 

w Annual Rpt, 1943, pp. 5-6. Note: Four grades below 75 on the mid-term was considered failing. 
See also 3d Ind. (basic Ltr,, AAG to TAG, through: TSG, 11 Feb 42), TAS, Hq. AAF, to Comdt., AAFSAM. 
27 Feb 42. 

190 Ltr., Comdt., AAFSAM, to Surg. Training Centers, 16 Mar 42. 
m Board Proceedings, 1942-43. 

192 Ltr., Exec. Med. Div., OCAC to Comdt., AAFSAM, 6 Nov 41. 
198 See n. 190. 

194 Memo for Directors, Teaching Depts., SAM, from Comdt., AAFSAM, 8 Sept 43. 

195 Annual Rpt, AAFSAM, 1944, p. 13. 

198 Research Rpt, AAFSAM, Project No. 200, Lt. Col. P. A. Campbell, 6 May 44. 
197 See n. 195. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROGRAMS 



227 



188 Noted on Efficiency Rpt, (WD AGO Form 67), AAF Officers Classification Card (WD AGO Form 
66-3), Classification Questionnaire for Med. Dept. Officers (WD AGO Form 178-2). Ltr., Actg. AS, Hq. 
AAF, Wash., D. C, to Comdt., AAFSAM, 12 Apr 44. 

199 1st Ind. (basic ltr., Comdt., AAFSAM, to AAF, Off. of TAS, 5 Jul 44) TAS, Hq. AAF, Wash., D. C, 
to Comdt., AAFSAM, 13 Jul 44. 

2U0 Ltr., Special Asst. to AS, Hq. AAF, Wash., D. C, to Comdt., AAFSAM, 21 May 45- 

801 Book of Graduates, Flight Surgeons, AAFSAM, 1940-45. 

902 Ibid. 

203 Ibid. 

^"Ltrs., 1943-44, Student Failures. 

205 Ltr., Actg. Comdt., AAFSAM, to CG, AAF, Off. of TAS, Wash., D. C, 12 Jun 4 3- 
Ltr., Actg. Comdt., AAFSAM, to CG, AAF, Off. of TAS, Wash., D. C, 31 May 43. 

207 2d Ind. (basic ltr., W. F. Smith to CG, AAF, Wash., D. C, 10 Sept 42), TAS, Hq., AAF, Wash., 
D. C, to Comdt., AAFSAM, 29 Oct 42. 

208 AR 350-570, 31 Oct 1940, Sect. I, Par. 8, par d; WD Cir. 72, 9 Jul 40, par. 2, Sect. I. 

209 AR 40-10, Par. I, WD, Wash., D. C, 17 Nov 41. 

230 AAF Reg. 25-5, 17 Jun 42. 

211 AAF Reg. 25-5A, 31 Jul 42. 

212 1st Ind. (basic ltr., Lt. Col. W. J. Kennard, to TAS, AAF, Wash., D. C, 26 Aug 42), Comdt., 
AAFSAM, to CG, Hq., AAF, Off. of TAS, Wash., D. C, 19 Sept. 42. 

2,3 AAF Reg. 25-5, 2 Mar 43. 

214 P. A. Campbell, A Method of Selection of Avn. Med. Examiners for Special Assignment, AAFSAM, 
Project No. 200, Rpt. No. 1, 6 May 44. Memo for Comdt,, AAFSAM, from Dir/Training, 15 Aug 44: 

215 AAF Reg. 35-52, 13 Apr 44. 

218 Announcement, Armv Extension Course, Sect. XIII, 1941-42. 

2d Ind. (basic ltr., C/AC to TAG, 10 Sept 40), TAG to C/AC, through: TSG, 23 Sept 40. 
3418 2d Ind. (basic ltr., TAG to C/AC, through: TSG, 24 Oct 40), AC/Med. Div., to Flight Surg., 31 
Dec 40. 

219 2d Ind. (basic ltr., TAG to Comdt., AAFSAM, through: TSG and C/AC, 18 Aug 41), Exec. Med. 
Div., OCAC, to Comdt., AAFSAM, 22 Aug 41. 

300 1st Ind. (basic ltr., Surg., SACTC, to Comdt., AAFSAM, 9 Mar 42), Comdt., AAFSAM, to Surg., 
SACTC, Maxwell Fid, Ala., 12 Mar 42. 

231 Ltr., Actg. Comdt., AAFSAM, to CG, AAF, Off. of TAS, Wash., D. C, 26 Aug 42. 
" Ltr., Comdt., AAFSAM, to CG, AAF, through: AS, 28 Nov 44. 

223 Annual Rpt, AAFSAM, 1941-44. 

™ Rpt of Graduates, AAFSAM, AME, Jul 44-Jun 45. 

Tib 1st Ind. and Inch (basic ltr., C/Research Div, Off. of TAS, to Comdt., AAFSAM, 3 Dec 45), Comdt., 
AAFSAM to CG, AAF, Off. of the TAS, Wash., D. C, 9 Jan 46. 

228 AR 350-3,000, 30 Mar 46. 

227 Ltr., Comdt., AAFSAM to CG, AAF, through: CG, GCACTC, Randolph Fid, Tex., 21 Apr 42. 
" 8 Ltr., Surg., Hq., VIII AF H. I., to Comdt., AAFSAM, 21 Sept 42. 

229 Ibid., 8 Nov 42. 

230 See n. 227. 

281 2d Ind. (basic ltr., CG, VIII AF, through: CG, Hawaiian Dept., Ft. Shatter, H. I., 11 Jan 43), TAS, 
Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 15 Mar 43- 

382 Ltr., Surg., Hq., VIII AF, ETO, to TAS, Hq., AAF, Wash., D. C, 7 Sept 42. 

233 2d Ind. (basic ltr., Surg. Hq., VIII AF, H. I., to Comdt., AAFSAM, 8 Nov 42), Actg. AS, Hq., 
AAF, Wash., D. C, to Comdt., AAFSAM, 8 Dec 42. 

284 Detlev Bronk, Rpt. of Inspection of the AAFSAM, 12-25 Jun 44. 

285 Ltr., Maj. Don Flickinger to Comdt., AAFSAM, 13 Nov 42. 

23a E. G. Reinartz, "A Flight Surgeon Looks at War," Roc^y Mountain Medical Journal, XLI (Jan 
1944), p. 20-26. 

237 W. A. Bachrach, "Combat Veterans Evaluate the Flight Surgeon,'* The Air Surgeon's Bulletin, 
II (Sep 1945), P- 279. 



228 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



w N. E. Collins and W. A. Bachrach, Comments by AAF Returnees on the Value of the Flight Surgeon, 
19 May 45. 

239 Ltr., Asst. AS, Hq., AAF, Wash., D. C, to Comdt., SAM, 27 May 42. 
S40 Telegram, CG, AAF, Wash., D. C, to Comdt., AAFSAM, 3 Jul 42. 
141 Ltr., TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 19 Jun 42. 
242 Annual Rpt, AAFSAM, 1943, p. 18. 

143 Rpt., AG, AAFSAM, to Armed Forces Institute, Madison, Wis., 16 Nov 43. 

144 Annual Rpt., AAFSAM, p. 9. 

145 Ltr., C/Dept. of Physiology, AAFSAM, to Comdt., AAFSAM, 4 Nov 44. 
249 Program, AP, AAFSAM, 13 Nov-16 Dec 44. 

147 Weekly Schedule, Aviation Physiologists* Course, AAFSAM, 20 May-7 Jun 46. 

248 Ralph J. Greenberg, An Evaluation of the Altitude Training Program: A Medical Evaluation Program, 
Report AAF-AS-M, 43, AAFSAM Project No. 467, 25 Apr 46. 

249 Memo for Comdt., AAFSAM, from Capt. Herman S. Wigodsky, AAFSAM, 30 Jun 42. 
230 Ltr., Surg., AAFFTC, Fort Worth, Tex., to Comdt., AAFSAM, 18 Mar 43. 

281 Ibid. 

252 Ltr., Asst. Surg., AAFFTC, Fort Worth, Tex., to Comdt., SAM, 20 Nov 42. 

253 AAF Letter 50-130, sub: "Instructions Governing the Anti-G Training Program," 11 Jul 45, Imple- 
mented by T. C. Memorandum 50-0-10, 3 Aug 45. 

284 Excerpt, Hist., AFTRC. 

™ Ltr., C/Research Sec, Off. of TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 3 Jul 42. 
^Ibid., 31 May 43- 

207 Ltr., Dir/Dept. of Avn. Med., SAM, to Dir /Training, SAM, 3 May 43. 

288 AAF Reg. 55-7, AAF, Wash., D. C, 30 May 42. 

289 Ibid. 
260 Ibid. 

281 S. R. M. Reynolds, "Summary of Unit Oxygen Officer's Opinion of Demand Equipment," AAFSAM, 
Project No. 80, 22 Sept 42. 

282 See n. 260. 

263 Annual Rpt., 1943, p. 17. 

264 Rpt., Adj., AAFSAM, to U. S. Armed Forces Institute, Madison, Wis., 6 Dec 42. 
2-5 Ltr., Comdt., SAM, to CG, AAF, Off. of TAS, Wash., D. C, 20 Sept 43- 

266 Ltr., Comdt., AAFSAM to CG, AAF, Off. of TAS, Wash., D. C, 5 Jul 43- 
281 Ltr., Comdt., AAFSAM to CG, AAF, Wash., D. C, through: TAS, 8 Jan 43. 

John S. Gray, "Evaluation of the Performance of Unit Oxygen Officers," AAFSAM, Project No. 103, 
Rpt. No. 1,14 Jun 43. 

269 See n. 260. 

270 Maj. Richard J. Trockman (MC), "Personal Equipment Program in the Eighth Air Force," Air 
Surgeon's Bulletin, II (June 1945), p. 186-187. 

271 Ltr., TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 6 Nov 43. 

272 Ltr., C/Research Div., Off. of TAS, Wash., D. C, to Comdt., AAFSAM, 25 Oct 43- 

273 Memo for Comdt., SAM, from C/Personal Equipment Officer's Course, AAFSAM, 1 1 Dec 45. 

274 Ltr., C/Personal Equipment Officer's Course, AAFSAM, to Comdt., AAFSAM, 14 Jan 44. 
27B Ltr., Comdt., AAFSAM to Armed Forces Institute, Madison, Wis., 1 1 Nov 43. 

278 Rpt., Adj., AAFSAM, to Armed Forces Institute, Madison, Wis., n Nov. 43. 
277 Annual Rpt., 1944, p. 5. 

878 Book of Graduates, AAFSAM, 1943-44. 

279 Memo for Comdt., AAFSAM, from Actg. Comdt., AAFSAM, 1 Dec 43. 
230 AAF Ltr. 50-12, 31 Jan 44. 

281 See n. 248. 

233 Hist., Ill AF, Ch. II, "Aviation Medicine." 

283 Hist., Ill AF, Ch. II, "Altitude Training." 

284 Ltr., Hq., AAF, to All High Altitude Indoctrination and Classification Units, sub: "High Altitude 
Indoctrination and Classification Program," 19 Mar 42. 



SCHOOL OF AVIATION MEDICINE AND RELATED PROCRAMS 



229 



285 AAF Reg. 50-18, 14 Dec 42. 

2M AFTRC Memo, "Instructions Governing the Altitude Training Program." 17 Jul 43. 

287 This instruction was given along the lines contemplated in the new Night Vision Training Program, 
which is discussed in another chapter. 

288 See n. 283. 
"•Hist., I AF, 1942. 
290 See n. 282. 

201 IV AF Memorandum 50-501, 20 May 44. 
30 "IV AF Memorandum 52-151, 17 Oct 44. 
^Excerpt and Summary, Hist., FAF. 

294 See n. 248. 

295 Ibid. 

^The figure in the Annual Report considers only the runs in the old chamber. Many individuals, 
aviation medical examiners, medical technicians, and flight nurses received two runs, the second in the 
chambers at the research building. The figures here consider them as two separate man flights and 
represent the total man flights in all chambers. In addition there were quite a few animal flights which 
are not reflected in the above figures. Annual Rpt, AAFSAM, 1945, p. 94. 

297 Ltr., Comdt., AAFSAM to TAS, Hq., AAF, Wash., D. C, 6 May 42. 

2e * Ltr., C/Dept. of Physiology, AAFSAM, to Comdt., AAFSAM, 24 Mar 44. 

™*2d Ind. (basic ltr., C/Dept. of Physiology, AAFSAM, to Comdt., AAFSAM, 24 Mar 44), C/Research 
Div., Off. of TAS, Wash., D. C, 14 Apr 44. 

300 Ltr., TAS, Hq., AAF to Comdt., AAFSAM, 25 Oct 44. 

301 1st Ind. (basic ltr., TAS, to Comdt., AAFSAM, 25 Oct 44), Comdt., AAFSAM, to CO, AAF, Off. of 
TAS. 22 Nov 44. 

30J Ltr., Comdt., AAFSAM to CG, AAFSAM, 2 Jul 45- 
803 Ibid. 

* M Memo for Comdt., AAFSAM, from C/Dept. of Physiology, AAFSAM. 29 Nov 44. 

305 AAF Training Standard No. 130-2, sub: Emergency Rescue Units and Crews (Aircraft), 15 Feb 44. 
AAF Training Standard No. 110-1-1, sub: Training for Units and Individuals of the Medical Dept. of the 
AAF, 19 Jun 43. T/O & E No. 1-987, WD, 8 Nov 43. 

30tt AAF Ltr. 50-16, sub: Med. Training, 10 Mar 44, 

807 AAF Training Standard No. 110-2, 16 Mar 44. 

3U8 TC Memo No. 50-0-3, sub: Training, General, Altitude Training Program, 16 Mar 44. 
809 Ltr., Hq. AAFEFTC, sub: Altitude Indoctrination, 27 Jun 44. 

330 AAF Ltr. 50-28, sub: Instructions Governing the Altitude Training Program, 25 May 44. 

311 Excerpt and Summary, Ch. Ill, Hist. AFTRC. 

312 WD Cir. No. 48, 3 Feb 44- 

313 Hist., ASC, p. 79 ff- 
* 1A Ibid. 

315 Ibid. 

316 Ibid. 

317 Hist., Warner Robins Fid, Officer Training (1942-43). 

318 Ibid. 

310 AG Ltr., Establishment of an Air Forces Medical Service Training School, as cited in SAM History. 



Chapter IV 

RESEARCH 
AND DEVELOPMENT 



By the early 1930's the gap between aircraft performance and human 
tolerances had become increasingly critical. According to Armstrong in his 
Principles and Practice of Aviation Medicine, the "human element was be- 
coming the weakest link in the chain," thus creating an "urgent need" for 
further medical studies. 1 At the School of Aviation Medicine, research activities 
were primarily concerned with such matters as the selection of personnel and 
the physiological and psychological factors relating to the individual flyer. 
These aspects of aviation medicine would be continuing matters of concern, 
but now there was an added requirement to strengthen that "weakest link" 
of the air weapons system, the human element. 

Possibly more than anyone else in America Lt. Col. Malcolm C. Grow 
(MC), then flight surgeon at Patterson Air Field, was aware of this need; for 
in the course of his normal duties he came in contact with test pilots, 4 
miles away at Wright Field, who constantly sought his advice. Eventually 
he was given a desk in the Equipment Branch, Engineering Division, Wright 
Field, where he spent a part of each week in addition to his regular duties at 
Patterson Field. 2 His first major project was to determine the maximum per- 
centage of carbon monoxide permissible in the cockpit of experimental aircraft 
undergoing service test, a figure that was to be set at .005 concentration. His 
findings were published in a technical paper 3 in 1934, the first of its kind in 
the field. Subsequently it became a standard source for foreign countries as 
well as the United States. Illustrative of other projects undertaken in this 
period by Lt. Colonel Grow was research to develop less bulky flying clothing. 

It soon became apparent that a systematic research program must be estab- 
lished in the field of human engineering, and that the lag in research since the 
days at Mineola must now be overcome. Capt. Harry G. Armstrong (MC), 
who joined him shortly, was also interested and began collecting equipment, 



[230] 



RESEARCH AND DEVELOPMENT 



231 



including the old pressure chamber which had survived the fire at Mineola. A 
small laboratory was established in the basement of the Engineers' Building. 4 
Meanwhile, Lt. Colonel Grow was ordered to report to the Office of the Chief of 
Army Air Corps as Assistant Chief Flight Surgeon. Upon the retirement of 
Col. Glen Jones he became Chief Flight Surgeon and as such was in a position 
to defend and procure funds for the development of a permanent aeromedical 
research laboratory to meet the critical needs of military aviation. Nearly 
20 years later he recalled that there was opposition to his choice of the site 
at Wright Field rather than at the School of Aviation Medicine. It seemed to 
him, however, that the major need was "to keep the engineers aware of the 
human element" and that the way to do so "was to have medical officers nearby." 5 
The Laboratory was opened on 15 September 1934 with Colonel Grow and 
Captain Armstrong named as co-founders. On 26 June 1936 Dr. J. W. Heim, a 
former resident fellow and lecturer at the Harvard School of Public Health, 
reported for duty as Associate Physiologist. 6 In 1938 Dr. Ernest P. A. Pincoff 
joined the staff upon his graduation from the University of Rochester. In 
February 1941 Dr. D. B. Dill of the Fatigue Laboratory at Harvard joined the 
Laboratory as Director of Research. He was succeeded by Col. W. Randolph 
Lovelace, II. During the succeeding peacetime years the Laboratory, under the 
guidance of Major Armstrong, was to become the major aeromedical center 
in the United States and possibly in the world. Major Armstrong was suc- 
ceeded as Director on 16 September 1940 by Capt. Otis O. Benson, Jr. (MC). 
As war drew nearer, plans for expansion got rapidly under way. These plans 
included a new laboratory building which was officially opened a year later. 
As of late September 1941 there was an impressive staff of specialists on duty at 
the Laboratory. 7 

With entry of the United States into war, it was apparent that research 
activities at the School of Aviation Medicine would also have to be expanded. 
There is the story, however apocryphal it may be, of the senior officer at the 
School who shortly after Pearl Harbor had felt the pressures too much upon 
one occasion and exploded that "the School was a fine military installation 
until the damn war came along." Certainly the School was called upon to 
make an abruptly swift transition from peace to war and the volume of its work 
was measured in units of a thousand instead of units of one; but in the area 
of research the transition to meet the wartime mission was fruitful even if 
sudden. 

Major Armstrong, after leaving the Laboratory at Wright Field, had as- 
sumed duties as Director of Research at the School and was therefore in a 
position to view the total problem of aeromedical research in the Air Force 




Maj. Gen. Malcom C. Grow (MC). 




Maj. Gen. Harry G. Armstrong (MC). 



234 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 




Chart 5. Human factors in aircraft design. 




2G2297° — 55— 17 



236 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

with perspective and balance. The Air Surgeon, General Grant, had shown 
a keen interest in furthering research. Already he had given aggressive sup- 
port for funds and authorization to construct the new building at Wright 
Field which would be opened before many months; and now he gave equally 
of his support for a new research building at the School of Aviation Medicine. 
Major Armstrong, who had developed plans for the aeromedical buildings at 
Wright Field, would now plan for this new facility. In actual volume of 
work, the research activities at the School of Aviation Medicine was ultimately 
to exceed even that of the Aero Medical Laboratory. 

As early as January 1942 General Grant, Major Armstrong and Major 
Benson met in Washington to discuss plans and policies for the wartime research 
program. At that time, it was decided that the School of Aviation Medicine 
would retain jurisdiction over psychophysiologic problems while the Aero 
Medical Research Unit (as the Laboratory was called) would deal with the 
following areas of research: 

1. All medical problems with reference to Air Corps materiel. 

2. Problems of flight in which tactical efficiency is correlated with the machine. 

3. Medical problems arising from and related to engineering advancements. 

4. Effects of flight on man. 

Research which did not clearly fall into either of the general subdivisions 
would be carried out by that research agency best equipped by virtue of geo- 
graphic location, laboratory facilities or personnel qualifications. In the event 
of disagreement over jurisdiction, The Chief of the Medical Division, OCAC, 
would assign the problem. 

Coincident with the period of the 1942 War Department reorganization, 
the Laboratory of the Aero Medical Research Unit became, in the words of 
the Aero Medical report, "a full official laboratory." On 28 March 1942 the 
following plan was agreed to at a conference held at the Materiel Center, Wright 
Field, and attended by the Air Surgeon: 

a. The responsibility for the development of oxygen equipment rests with the Air 
Surgeon, Army Air Forces, who will exercise this responsibility and incident supervision 
through his representative at the Materiel Center,- the Chief of the Aero Medical Research 
Laboratory. 

b. The present Aero Medical Research Unit of the Equipment Laboratory, Experi- 
mental Engineering Section, will be organized as the Aero Medical Research Laboratory 
of the Experimental Engineering Section. 

c. The Aero Medical Research Laboratory will conduct continuing investigations 
to ascertain the physiological requirements of oxygen equipment, and will act in an advisory 



RESEARCH AND DEVELOPMENT 



237 



capacity to other Laboratories of the Experimental Engineering Section in the engineering 
developments necessary to fulfill these requirements. 

d. The Experimental Engineering Section will continue its present organization for 
the development engineering of oxygen equipment, the flight testing of experimental items, 
the preparation of specifications, and the coordination with the agencies of production 
control, procurement, storage, and issue. 

e. Action will be initiated to add the name of the Chief, Aero Medical Research Unit, 
to the various oxygen committees on which Lt. Col. Rudolph Fink, Air Corps, is now 
serving. Examples of such committees are the Technical Sub-Committee on Oxygen 
of the Standardization Committee of the Joint Aircraft Committee, the N. D. R. C. 
Committee on Oxygen Supply for Army and Navy, the N. D. R. C. Committee on Oxygen 
Mask Development, the N. D. R. C. Committee on Oxygen Problems, and the N. D. R. C. 
Oxygen Reviewing Committee. 

The organization and activities of the Laboratory were outlined by Major 
Benson on 22 June 1942 and published in the Experimental Engineering 
Section Office Memorandum No. 42-2A, Addition 1, which officially designated 
the Laboratory as such. It read in part: "Effective July 1, 1942, the Experi- 
mental Engineering Section is reorganized to include the establishment of the 
Aero Medical Research Laboratory." That Laboratory was "charged with the 
responsibility of conducting research in the general field of aviation medicine, 
to the end that the lives, health, and efficiency of flying personnel shall be 
protected and enhanced." When Colonel Benson became Surgeon of the newly 
organized Fifteenth Air Force in September 1943 he was succeeded by Colonel 
Lovelace who held this position through the remainder of the war. 

Summing up the accomplishments of the Laboratory, Armstrong in his 
Principles and Practice of A viation Medicine wrote : 8 

Generally speaking, the work of this laboratory has been directed to the study of the effects 
of flight on the human organism and the development of methods or means of neutralizing 
or eliminating those influences in military aviation which are detrimental to the efficiency, 
health or life of flying personnel. The findings of this laboratory have greatly influenced 
the design, construction and operation of military aircraft and the design of protective 
flying equipment, insofar as the human element is concerned, and gained wide recognition 
for its contributions to medical science in the field of aviation. 

Thus, aeromedical research was located primarily in two large centers: 
the School of Aviation Medicine and the Aero Medical Laboratory. Other 
AAF agencies, such as the Flying Safety Command with Headquarters in 
Winston-Salem, N. C, were also concerned. Some of the major developments 
are described below. Individual research projects initiated in the theaters are 
discussed in subsequent chapters dealing with overseas operations. 



238 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

Anthropology 9 

It had been recognized quite early in the history of the Laboratory that the 
need for exact knowledge of human variations and dimensions was even greater 
in aviation than in the older military and naval arms because of the paramount 
importance of space. Flyers were fitted into spaces which were initially kept to 
a structural minimum by aircraft designers and were thereafter subject to con- 
tinual encroachment for tactical purpose. In addition, the extremes of tem- 
perature and pressure encountered made the fit of personal equipment (such 
as oxygen masks and flying clothing) a matter of survival itself. The Army 
Air Forces, with a highly selected population of flyers, had no body of data 
comparable to that available in Army anthropology to the Army Ground and 
Service Forces. As a result, it became evident during the great expansion of 
the Army Air Forces, beginning in 1940, that shortages in some sizes of flying 
clothing and surpluses in others were occurring; certain escape hatches were 
too small for safety ; and, most serious of all, gun turrets were imposing a severe 
limitation on the size — and, consequently, on the number — of gunners able 
to operate them. 

In the summer of 1940 Capt. Otis O. Benson, Jr., then an Army flight 
surgeon, was assigned to the Harvard Fatigue Laboratory for intensive research 
on the physiological problem of high altitude flying. Aware of the increasing 
importance of human sizing problems in aviation medicine and engineering, 
Captain Benson realized, in discussions with Dr. Earnest A. Hooton, professor 
of anthropology at Harvard University, that physical anthropology had the 
techniques of measurement and analysis appropriate to such problems. A 
tentative anthropometric project was agreed upon. Later, as Chief of the Aero 
Medical Laboratory (then the Aero Medical Research Unit), Captain Benson 
was strategically situated to coordinate anthropological research at all stages 
with the Aircraft, Armament, and Equipment Laboratories. Thus these labora- 
tories could pose the problems: How much clearance does the average (or the 
extreme) pilot or gunner need above his head or across his shoulders? Where 
should a range pedal in a ball turret be located ? How many sizes of oxygen 
masks, clothing or parachute harnesses are necessary, and what proportion of 
each size should be produced? Knowing this, the Aero Medical Laboratory 
could select techniques and subjects to answer such questions and could translate 
its anthropometric data into the appropriate engineering terms. At the same 
time, the close association of the Aero Medical Laboratory with the Office of 
the Air Surgeon, at AAF Headquarters in Washington, would facilitate the 
use of anthropology in the selection of personnel. 



RESEARCH AND DEVELOPMENT 



239 



Turrets constituted the major problem at the time, as already mentioned. 
Accordingly, in February 1941 Captain Benson invited Dr. Hooton to Wright 
Field to inspect American and British turret models and to draw up a list of 
body measurements important in turret design. Dr. Hooton's findings empha- 
sized the advisability of a general survey of AAF flyers, both cadets and gun- 
ners, to determine what proportion of flyers could use existing equipment, what 
size criteria would be desirable in their selection, and how existing equipment 
might be modified and future material designed to accommodate the largest 
possible number of flyers. 

Preliminary plans for the survey were under way when the United States 
entered the World War II in December 1941. After a brief period of uncer- 
tainty, it was decided by higher military authority that if the survey would have 
been useful in peacetime, it was even more necessary in war. Permission was 
granted by the Air Surgeon, and the survey proceeded at an accelerated pace. 

It was felt that the more problems to which an anthropometric survey could 
be applied, the greater its value. And since there were, in fact, a variety of 
problems involving human dimensions, it was decided to include general meas- 
urements and observations as well as those required for the turret study. The 
alternatives would be to make a separate survey as each type of problem 
occurred or to take at one time as many measurements as might conceivably 
be useful for any problems. Neither of these alternative procedures was fea- 
sible in view of the urgent time element, the desirability of large numbers of 
subjects, the impossibility of foreseeing all the anthropological problems which 
might arise in the future, and the desire to interfere as little as possible with the 
subjects' training schedules. The decision to include general traits was sound 
scientifically, as well as practical, since the basic measurements taken had been 
found to aff ord reasonable prediction of those subsequently required. 

The Anthropological Survey Blank thus contained measurements dictated 
by turret problems plus others chosen for general utility. The blank was drawn 
up by Capt. A. P. Gagge, representing the Aero Medical Laboratory, and Drs. 
Hooton and Carl C. Seltzer of Harvard University* The indices and the data 
on the obverse of the blank represented a combination of scientific interest, mili- 
tary utility and an attempt to afford a physical basis for differential training of 
personnel. Thus, the sociological background data, so easy to obtain while the 
subject was waiting his turn, and so valuable in anthropological research, could 
be used as a check on the representativeness of the sample. Applicability of 
Air Forces data to other branches of the Armed Forces would be limited if 
significant racial, regional or occupational differences appeared. Pigmentation 



240 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

and the rough index of skin sensitivity afforded by the "vascularity" test (esti- 
mation of reaction to a standardization scratch on the chest) had already found 
application in estimating susceptibility to sunburn and the need for goggle pro- 
tection — both requests received by Dr. Hooton from the Office of the Quarter- 
master General. 

In compiling the data sheet, time required for completion was a major 
consideration. Only after assurance that a trained observer could fill one in 12 
minutes was it approved. 

Once the data sheet had been drawn up, the survey was organized into 
observation and analysis, to proceed concurrently. Two teams of two observers 
each took the measurements and mailed them back to Harvard University at the 
end of each day — each observer's material being sent in a separate envelope to 
minimize the effect of a possible loss in transit; actually, none occurred. At the 
Peabody Museum, the data were coded and punched on International Business 
Machine cards as received, awaiting completion of the series. Trends could 
thus be observed, and incipient deviations in technique or interpretation arrested. 
For urgent problems, a tabulation of the most important dimensions for turrets 
was prepared for the first thousand subjects and sent to Wright Field before 
the series was completed. 

In addition to Captain Benson and Captain Gagge of the Aero Medical 
Laboratory, Dr. Hooton, Consultant, and Dr. Seltzer, Assistant Consultant, of 
Harvard University, the observers were Albert Damon, Francis E. Randall, 
Judson T. Shaplin, and Ivar Skarland; the statistical analysts were Dr. Alice M. 
Brues and Mrs. Agnes W. Beghard. The measurements for the body size survey 
were taken during March and April 1942. Mr. Shaplin left the project in 
May; and in July, 2 months after the three remaining observers had returned 
to the Aero Medical Laboratory from the field, Mr. Skarland left. Damon and 
Randall remained with the project as commissioned officers. Subsequent addi- 
tions to the project included Dr. Brues and Lt. Robert S. Benton, anthro- 
pologist; Sgt. Robert C. Koepnick and Miss Alice King, sculptors and techni- 
cians; and Pfc. James H. Thomas, plastics expert. All four observers were 
students of Dr. Hooton and trained in the Sheldon system of analyzing body 
build. In addition to this initial similarity of training, 3 weeks were spent 
exclusively in standardizing techniques, so that when the observers entered the 
field their procedures were thoroughly comparable. 

In 1941 and 1942 there were three AAF stations through which all aviation 
cadets were sent after passing the physical examination for flying: Maxwell 
Field, Montgomery, Alabama; Kelly Field, San Antonio, Texas, and Santa 
Ana Air Base, Santa Ana, California. Aerial gunners were being trained 



RESEARCH AND DEVELOPMENT 



241 



at the Harlingen Army Gunnery School, Harlingen, Texas; Tyndall Field, 
Panama City, Florida, and Las Vegas Army Gunnery School, Las Vegas, 
Nevada. One team of two observers was sent to Maxwell and Tyndall Fields, 
and another to Kelly and Harlingen. Unfortunately, there were not enough 
observers to include the western fields, Santa Ana and Las Vegas, of which the 
former especially drew men from the Pacific Coast. This omission (only about 
2 percent of the entire survey are from the Pacific States) diminished the repre- 
sentativeness of the sample and might have changed the observed distribution 
of traits significantly for the anthropologist but probably not for the aviation 
engineer. At Kelly and Maxwell Fields, 2,954 aviation cadets were measured, 
and at Tyndall and Harlingen, 584 gunners, the entire gunner population of 
these schools at the time. 

The general body size survey always constituted the backbone of the project, 
but supplementary surveys became necessary as new problems involved special 
measurements or populations. For example: (1) In the construction of the 
manikins described below, additional measurements were necessary, since those 
taken in the basic survey could not suffice for a three-dimensional, full-scale 
model of a flyer. The required measurements (such as ankle and crotch 
height, arm and leg circumferences) were accordingly taken on a small, selected 
sample of Aero Medical Laboratory personnel. (2) In connection with studies 
on the relation of physique to susceptibility to high altitude "bends," 152 
photographic reconnaissance pilots, 40-odd University of Cincinnati Medical 
School students and 29 Aero Medical Laboratory subjects were somatotyped. 
(3) Special combat equipment designed for pursuit pilots involved several spe- 
cial body circumferences. These were taken, together with the routine stature 
and weight, on 164 pilots. 

Experience in the clothing sizing program, to be described below, demon- 
strated a conclusive need for specific tailors' measurements (such as sleeve out- 
seam waist and seat circumferences, and leg inseam), taken according to stand- 
ard trade practice. Trade formulas for predicting these dimensions from height, 
weight, and chest circumference were checked and, when modified as required 
to fit the AAF series, gave workable but still not entirely satisfactory results. 
The need for a separate clothing survey was emphasized by the fact that many 
garments were issued to specialized groups of aircrew; for example, electrically 
heated suits were worn only in bombardment airplanes. Since bombardment 
officers, bombardment enlisted aircrew (gunners) and pursuit pilots differed in 
size, and since the basic survey made no distinction among cadets, it was neces- 
sary to obtain clothing size schedules for each group separately. Accordingly, 
a detailed array of clothing measurements were taken during March and April 



242 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



1944, for 315 pursuit pilots and 983 bombardment aircrew (419 officers and 
564 enlisted men). 

The increasing utilization of women in various flying capacities posed fur- 
ther problems of selecting personnel and designing equipment; accordingly, 152 
flying nurses and 447 WASP's (Women's Army Service Pilots) were added to 
the body size surveys. 

During the original body size survey, a special problem arose in the fit 
of oxygen masks. So urgent was this that application of the body size data was 
postponed until the mask problem was well on its way toward solution. The 
transition from a "free-flow" to a "demand" oxygen system, in which economy 
is effected by supplying oxygen only on inspiration, meant that the mask had 
to fit the face as closely as possible. An additional necessity for close fit was 
imposed by tactical requirements of aircraft able to fly at ever higher altitudes, 
since the higher the altitude, the more serious became a given leak. To afford 
a basis for an analysis of mask design and sizing, measurements useful for this 
purpose, as well as general head and face dimensions, were worked out by Drs. 
Hooton and Seltzer and Lt. Colonel Gagge, and were taken on 1454 additional 
cadets during April and May 1942. Unfortunately, head circumference was 
not originally included, since it had been taken in the body size survey, but was 
soon restored to its proper place in the head and face battery. 

Just as the construction of manikins required supplementary body measure- 
ments, so the AAF head types (described below) required special head and 
face measurements (called "orientation" measurements, since they enable the 
points on the blank to be located in three dimensions), which were taken on 
a series of 196 (150 AAF flyers and 46 Aero Medical Laboratory personnel). 

The inclusion of Negro flyers in the AAF complicated the mask problems. 
Would standard designs and sizes fit Negroes? What proportions of the stand- 
ard sizes would they require? To answer such questions, 132 ROTC cadets 
at Wilberforce University, representative of Negro AAF flyers, were added to 
the facial survey. It was found that Negroes were fitted by standard sizes but 
required a greater percentage of the large size. 

Would older flyers differ from cadets in head and face dimensions ? Would 
pursuit and bomber pilots have essentially similar measurements, or would a 
selective factor operate to alter the proportions of mask sizes which should be is- 
sued to these groups ? To answer these questions, 150 pilots, chiefly of bombers, 
196 pursuit pilots, and 239 officers and 286 enlisted men of bombardment crews 
were measured in the facial survey, as were hundreds of photographic recon- 
naissance and other flyers at Wright Field for high-altitude indoctrination. 
Similar questions in regard to women flyers led to the inclusion of 142 flying 



RESEARCH AND DEVELOPMENT 



243 



nurses and 440 WASP trainees in the facial surveys, essentially the same indi- 
viduals measured in the women's body size surveys. 

The several large series above constituted the basis for most of the current 
applications of body size to the design and sizing of flying equipment. As 
already mentioned, smaller series of 20 to 50 carefully selected individuals of 
the Aero Medical Laboratory were constantly being measured as special prob- 
lems arose — for example, the amount of decrease in "sitting height" on looking 
straight up, the average slump from the erect "sitting height" as measured in 
the survey to the normal relaxed sitting position, and special hand measurements 
necessary for glove sizing. 

A class of data hitherto not very extensively studied but of the utmost im- 
portance for aviation engineering (or, for that matter, human engineering in 
general) was the range of movements in various operations and positions of the 
body. Such studies were made for the prone position and for the head and eye 
movements involved in sighting from turrets. The following table summarizes 
the studies conducted : 

Table 16. Major Surveys of the Army Air Forces Anthropological Projects 



Body Size Surveys: 
General: 

Cadets 2, 954 

Gunners 584 



Total 3,538 



Clothing: 

Bombardment officers 419 

Bombardment enlisted men 564 

Pursuit pilots 315 

Pursuit pilots, special equipment 164 



Total 1, 462 



Somatotypes 221 

Total body size 5>22i 

Facial Surveys: 

Cadets 1, 454 

Assorted aircrew 871 

Negro ROTC 132 



Total facial 2, 457 



244 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

Table 16. Major Surveys of the Army Air Forces Anthropological Projects — 

Continued 

Women Flyers: 

WASPS*.. 447 

Flying nurses* 152 

Total women 599 

Grand total 8,277 

•Essentially same figures for body size and facial surveys. 

Full scale head and body models representing physical types of AAF flyers 
proved to be a highly successful and widely used means of translating anthro- 
pometric tables into practical terms, thereby presenting the flyer to the designer 
of aeronautical equipment as a tangible datum to be integrated with other 
objects that happened to be mechanical. (It was found true that in the initial 
stages of airplane and turret design all claimants for the limited space had been 
at hand and impossible to overlook except the flyer, who had, in consequence, 
been relatively neglected). Seven busts and three plastic, jointed manikins 
were constructed (5 June 1943) by a sculptor, Mr. G. W. Borkland of Chicago, 
working under the close supervision of the Wright Field anthropologists. All 
were exact to the millimeter in 40 to 50 dimensions. Three manikins repre- 
senting AAF women pilots (WASP's) were likewise constructed. 

The seven head types were designed during the summer of 1942 in connec- 
tion with oxygen mask sizing, when some indication was needed of averages 
and extremes in flyers' faces. The basis for classification was nasion-menton 10 
face length, considered by all mask designers and shown by actual experiment 
to be the most important single dimension for sizing. The nasion-menton 
range, from 101 to 146 mm., was divided into equal thirds, since the usual three 
sizes of mask, theoretically non-overlapping, should be based on divisions of 
the range rather than of the population. The average face length of the 
middle third virtually coincided with that for the whole group. The average of 
all other head and face dimensions for flyers with the average face length was 
Type I; Types IV and V represented the average of every other head and face 
dimension for the short and the long third, respectively, of face length. At the 
extremes, Types VI and VII represented the shortest and longest few millimeters 
of face length (roughly, 1 percent of the group of either end). As for Types II 
and III, it had been observed during the course of the mask study that subjective 
estimations of face length, frequently made and used by mask designers as a 
basis for sizing, were unduly influenced by face shape. That is, a narrow face 
was much more likely to be considered "long" than a broad face, regardless of 



RESEARCH AND DEVELOPMENT 



245 



the actual nasion-menton dimension. To illustrate the error inherent in such 
judgments, Types II and III both had the (average) face length of Type I, but 
Type II represented the smallest and Type III the largest of every other measure- 
ment occuring in faces of this average length (123, 124, and 125 mm.). 

The practical orientation of AAF anthropology was well illustrated by the 
foregoing paragraph. Military requirements dictated the decision to construct 
head types from the anthropometric data, as well as the selection of nasion- 
menton as the basic dimension ; the division of the range rather than of the popu- 
lation, and into just three parts; and the choice of the seven head types within 
these divisions. This set of heads was but one of many that might be derived 
from the basic survey. For example, a set of four, based on head circumference 
and height, was constructed (7 May 1944) to serve as standard test blocks for 
helmet inspectors, thereby dispensing with counterparts of Types II and III. 
Before this set existed, a steel helmet for aircrew based on Type V (long third 
face length) was adopted as standard and afforded a reasonably good fit for 
combat aircrew. 

The three plastic, jointed manikins were originally requested (June 1943) 
by aircraft engineers for use in plane mock-ups, which are preliminary models 
where exact details of dimension and location are worked out before the design 
is "frozen" for production. For cockpit clearances, sitting height and leg 
length were the important dimensions, making stature the best single basis for 
sizing the manikins. The stature range, from 156 to 198 cm., was divided into 
equal thirds; Type A, with a stature of 175.4 cm * (69 inches), was the mean of 
the entire series in all measurements; Type B, 166.5 cm. (65.5 inches), repre- 
sented the short third of the stature range and the short 17 percent of the series; 
Type C, 186.3 cm. (73.5 inches), included the tall third of the range and 9 per- 
cent of the population. The stature distribution of the population was asym- 
metrical due to the method of selection of aviation cadets, who then had officially 
a lower limit of 64 inches and an upper of 76 inches, despite the presence of a 
few individuals in the series outside these limits. Since a larger portion of the 
population was excluded at the lower extreme than at the upper, division of 
this curtailed range into equal thirds placed more subjects in the lower than in 
the upper third. 

The manikins were made of cellulose acetate, a light, strong and transparent 
plastic. They were sturdy enough to be fitted with flying clothing and para- 
chutes and could assume many positions, such as standing, sitting or kneeling 
in the bombardier's position. Within the limitations imposed by their being 
based primarily on stature, they were applicable to many problems besides cock- 



246 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



pit design involving body size. One use was as dummies in firing tests of 
armor protection in airplanes. 

Another type of manikin, a l / 8 scale, two-dimensional, jointed figurine, was 
widely used in the aircraft industry to check dimensions in drawings and blue- 
prints of airplanes. Such manikins, with dimensions based on the AAF survey 
and representing AAF flyers better than those previously employed, were con- 
structed and supplied to aircraft designers for this purpose. 

Two general reports (5 August 1942 and 3 October 1942) on body size in the 
AAF were prepared. The first, a modification abridgement of the analysis of 
the basic body size survey prepared at Harvard University under Dr. Hooton's 
supervision, presented percentile values, from 5 to 95 percent, for each trait and 
included correlation tables between pairs of measurements important for cockpit 
and turret clearances. This report proved indispensable for laboratory research 
at Wright Field, but proved too technical for general industrial use. A 
second report, in simplified graphic form, omitting correlations and including 
increments added to each dimension by various flying clothing outfits, was more 
successful for the latter purpose. 

The experience gained in specific fields was utilized in devising other 
special reports in terms familiar to specific industries. Thus, dimensions rele- 
vant to turrets were presented in terms of structural clearances and tolerances, 
while Tables of Clothing Sizes were prepared like those used in the clothing 
industry. 

An entirely different undertaking was the study of movements involved in 
various positions of the body. Considerable importance was attached to the 
prone position in aircraft, since the aerodynamically ideal fuselage was severely 
constricted vertically, and since effects of "G," or high accelerative forces, were 
better withstood in the prone position. A study was made (February 1944) 
providing basic data on comfort, visibility, and the variety and strength of 
movements attainable in the prone position; and head and body harnesses were 
devised. A study of head and eye movements in sighting, made at the request 
of a leading turret manufacturer, is described more fully in the section below. It 
appeared to have wide potential applications and illustrated another type of 
fundamental research which physical anthropology could conduct for the 
mechanical engineer. 

As the source of information on body size in the Army Air Forces, the Aero 
Medical Laboratory received frequent requests concerning dimensions of AAF 
flyers from various agencies. For example, techniques and data were supplied 
to the Armored Medical Research Laboratory, Armored Command, Army 
Ground Forces, for setting up a similar project; ear dimensions were supplied to 



RESEARCH AND DEVELOPMENT 



247 



the Navy (for earphones), and interpupillary distance to the Bureau of Stand- 
ards (for goggles) ; and body areas and percentages of the most "vital" areas 
were calculated for the three manikin types in connection with wound ballistics 
and firing tests of body armor. 

Turrets posed the major problem involving body size when the AAF survey 
was undertaken, and the problem, it will be recalled, was twofold: to estimate 
percentages of flyers accommodated by existing equipment, and to improve or 
design equipment to fit the maximum number. Similar problems encountered 
in tank turrets led to a similar project by the armored forces, as noted above. 

All standard AAF turrets and many experimental ones were analyzed by 
selecting and measuring several individuals representative of AAF flyers, as 
found in the survey, outfitting them in standard flying gear, having them operate 
the turret as a gunner would, noting the difficulties encountered due to cramp- 
ing, faulty location of mechanism or uncomfortable position and movements, 
and comparing the relevant dimensions of subject and turret in such cases. 
These dimensions could then be located as percentiles in the basic body size 
survey; percentages of AAF cadets and gunners accommodated could be esti- 
mated, and specific suggestions for improvement made. After all the standard 
turrets had been so analyzed, it was possible to recommend to the Air Surgeon 
upper limits on the height and weight of gunners, based on the knowledge that 
raising the limits above 70 inches and 170 pounds would result not in more 
gunners but in more misfits. This recommendation was accepted. An interest- 
ing anthropological point was that, although neither height nor weight was 
itself critical in turrets, the correlations between these dimensions and those that 
were critical were so high (for AAF flyers) that the former could serve as a 
rule-of-thumb for selection, without burdening medical examiners with special- 
ized measurements like bideltoid, sitting height and buttock-knee. 

In virtually all turrets it was found that changes which were minor mechan- 
ically and which could be made without materially slowing production would 
improve conditions greatly. They were called to the attention of armament 
engineers at Wright Field and in the industry, and many of the suggested modi- 
fications were adopted. The final step was to apply anthropological data to 
turret design in the initial stages, since it was much easier to modify a blueprint 
or a mock-up than a production model. This was accomplished by visits to major 
turret manufacturers, where reports on specific turrets and on dimensions of 
AAF flyers and equipment were discussed and transmitted. Representative 
employees were selected, measured, and their measurements located in the 
AAF series, and mock-ups of new turrets inspected and analyzed from the 
gunner's standpoint. 



248 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

The gunner's standpoint developed to include comfort, efficiency, visibility 
and safety. The first two were covered by the analysis described above. The 
gunner's vision was obviously of supreme importance in turret design. Based 
on the normal eye position, visibility was measured in all standard turrets and 
suggestions made for improvement. The "normal eye position" was fixed by 
the gun-sight location, the seat being adjustable up and down to bring the eye 
of gunners of varying sitting heights in line with the sight. But location of 
the gun-sight itself was supposed to be based on normal position and movements 
of the head and eye in sight. Precise knowledge of the positions of head and 
eye when the gunner was sighting in various directions was lacking, with two 
results: (i) insufficient space was being allowed for the head, and (2) gun-sight 
movement during elevation and depression of the guns was frequently fatiguing 
to follow. As mentioned earlier, a study of sighting movements were made/ 1 
and the results were distributed to all turret manufacturers and were integrated 
with optical requirements in the design of turret domes and sighting panels. 

Attempts to increase safety in turrets were directed along three main lines: 
(1) design of parachutes to be worn in turrets, (2) facilitation of entrance, exit, 
and emergency escape, and (3) armor protection. Special provisions along all 
these lines were considered necessary if the turret gunner was to have the chance 
that was his due. Progress was made in all three; for example, certain turrets 
were designed to permit direct parachute escape, and special steel helmets 
developed for turret gunners. 

The steel helmet story was an interesting epitome of the entire AAF anthro- 
pological project. The high percentage of casualties caused by head wounds 
from low-velocity fragments led to the requirement that all bombardment 
crews wear steel helmets. In the fall of 1943 Brig. Gen. Malcolm C. Grow, then 
Surgeon of the Eighth Air Force, had completed the design of a light steel hel- 
met to stop such fragments, based on AAF Head Type V of a set which he found 
in the RAF Medical Research Center. At the same time, the Ordnance De- 
partment in this country modified the standard infantry helmet to fit over flying 
headgear. The latter helmet afforded more protection than the Grow design 
but was larger, and the problem was whether one or two helmet types should be 
standardized. Data on head size and turret clearances gathered during the 
above turret study showed that the Ordnance helmet could not be worn in most 
turrets, whereas the Grow helmet could, thus assisting in the decision that two 
types were necessary. Other data, similarly gathered, were utilized (1) in de- 
termining procurement percentages of the two helmets, (2) in the design of 
a new and smaller helmet by the Ordnance Department, and (3) in modifying 



RESEARCH AND DEVELOPMENT 



249 



the Grow helmet, later standardized for turret wear, to fit the entire range of 
head size in AAF flyers. 

The turret study proved to be a continuing project at the Aero Medical 
Laboratory. Based on the studies just described, a set of requirements for gun- 
ners' provisions in local-control turrets was prepared 11 and distributed by the 
Armament Laboratory to all turret manufacturers as the Army Air Forces' 
version of good practice in turret design. In addition, some of these require- 
ments were incorporated into formal specifications to be met by all new local- 
control turrets. New turrets were routinely examined as they appeared, and 
efforts to improve the gunner's lot continued. 

The field of aircraft design, the surface of which had barely been scratched 
by the AAF anthropological project, offered exciting prospects for human engi- 
neering or "bio-mechanics." Because of the time lag betweeen airplane design 
and production, and because of the military pressure for production, anthropol- 
ogical applications thus far had been chiefly concerned with accessories in pro- 
duction aircraft. Airplane design proper, a long-term project, had been studied 
mainly in the mock-up stages of experimental planes which might fly in a 
few years, if at all. Investigations had been made of the need for imposing 
additional size limitations on pursuit pilots for certain planes, and of the desir- 
ability of placing a lower limit on size of women pilot trainees. It was found 
that neither limitation was required. 

The military importance of air transportation of combat troops, passengers 
and the wounded developed strikingly during World War II, posing problems 
in the economy of space that were hardly conceived hitherto. In this connec- 
tion, data were supplied for the location and dimensions of seats and windows 
in cargo and troop-carrying planes. A new seat back was designed, based on 
dimensions of troops, proper location of supporting members, and provision 
for the assumption of postures minimizing motion sickness. The transition 
just illustrated, from size analysis to original design, was observed in connection 
with prone position harnesses and was encountered again in oxygen masks, 
gloves and the oxygen clip tab on outer garments. 

One of the most interesting of all the applications of anthropology to 
military aviation was the analysis of proposed airplanes from the flyer's point 
of view during mock-up inspections. Recommendations were made and ac- 
cepted on size and location of escape hatches, location and adjustment of pilots' 
seats, gunners' sighting systems and movements and supports for various 
positions of the body. 

It was a logical step in anthropological analysis from cramped turrets to 
crowded cockpits. Data on pilots' dimensions were made available to odier 



290 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

AAF agencies conducting similar research, which included "streamlining" 
cockpits to reduce crash injuries; design of seat for comfort, efficiency, and 
safety; and arrangement of windshields and gun-sights based on the pilot's eye 
position. 

Proposed "safety engineering" studies included the establishment of mini- 
mum dimensions for escape hatches, based on measurements of large flyers in 
full gear, and a general project to determine location and dimensions of escape 
hatches, passageways and installations to protect personnel during crash landing 
and "ditching" (forced landing on water). 

As might be expected from the nature of wartime research in military 
anthropology — a series of immediate, urgent requirements — personal equipment 
received more attention than any of the other major applications of AAF anthro- 
pology. In personal equipment the relation of man to material was immediate 
and obvious. The projects already described — selection of personnel, construc- 
tion of full-scale models, gun-turret and airplane design — were relatively long- 
term undertakings, involving the indoctrination of military aviators and engi- 
neers in a point of view. Such studies could hardly be carried on when, for 
example, sudden tactical developments led to an urgent request from a combat 
theater for a larger number of oxygen masks or garments that were still experi- 
mental, and the number of sizes, dimensions of each size and proportions of 
each size in the total were required to be "immediately" worked out; or when 
manufacturers were continually submitting pre-production samples of garments 
which required testing for size before production might begin; or when past 
deficiencies had to be remedied or new ideas incorporated as soon as possible 
in the full course of production, where every day meant thousands of items. 
Quite properly, most of the time and volume of work of the AAF anthro- 
pological program was devoted to personal equipment. 12 

The following brief account of the oxygen mask study can only indicate 
some highlights of this intriguing problem. Since the first attempt to apply 
anthropometry to aviation medicine, its emphasis had long since shifted from 
analysis and evaluation to original design. Even before the head models were 
constructed, all available masks, allied and enemy, were thoroughly tested for 
fit on sizeable series of individuals measured according to the Facial Survey 
Blank. Successes and failures of each size of each mask were related to facial 
dimensions, and proportions of AAF flyers fitted could thus be estimated. 
Recommendations were made for redesigning and resizing, and specific data 
supplied, with the result that subsequent masks had a much greater percentage 
of fits. It was determined that three sizes were necessary for AAF masks, and 
the percentages of these sizes were established for general production and for 



RESEARCH AND DEVELOPMENT 



251 



issue to specific groups of flyers. It was found, for example, that fighter pilots 
and especially photographic reconnaissance pilots required a larger proportion 
of small and medium sizes than did bombardment crews. 

Based on anthropometric data and on consideration of the goggles and 
helmets with which masks must be integrated, a new mask was designed and 
developed. This was finally standardized as the A-13, described under the 
section on oxygen equipment. It proved to fit virtually all AAF flyers, in- 
cluding women, and to be suitable for a number of purposes, including resusci- 
tation of unconscious flyers. Other types of masks, such as a full-face mask 
incorporating goggles for waist gunners, and combinations of plastic and rubber 
materials were experimentally designed. 

Anthropometric data were translated into tailors' measurements in Tables 
of Sizes and Percentages, as noted, and were supplied to the organizations 
developing and engineering the production and procurement of AAF flying 
clothing. Jackets, trousers, helmets, and gloves were thus sized, and a table for 
shoes planned. These tables were routinely utilized in the design, sizing, pro- 
curement and issue of flying and other clothing for AAF flyers. Thus, the num- 
ber of sizes required and the dimensions for each size were tentatively established 
for a proposed garment, based on knowledge of its function, design, material 
and associated clothing. A sample of each size was made and tested on subjects 
of known dimensions, and the size schedule modified as required; more or 
fewer sizes might be necessary, or different dimensions indicated. These di- 
mensions were included in the specifications. Finally, the percentages of each 
size in the total production was determined. 

As for actual production garments, samples of flying helmets were routinely 
submitted for size tests before manufacturers were permitted to begin full pro- 
duction, and periodic samples of all garments were routinely inspected for con- 
formity with the dimensions in the specifications. A study of glove sizing led 
to the construction of model hands and to the experimental design of gloves 
with curved fingers. A lighter touch was afforded by the determination of 
the required range of adjustment in suspenders to be worn with high-waisted 
and low-waisted trousers. 

A consideration frequently, overlooked by airplane, turret and clothing 
designers was the bulk inherent in most flying clothing. It was found that 
even in electrically heated clothing, adequate insulation entailed bulk which, in 
the limited space available, could not be disregarded and might actually impede 
efficiency. Increments added by various standard outfits (shearling, electrically 
heated, and down-filled) to each dimension measured in the body-size survey 
were determined and compared. These figures indicated relative percentages of 

262297°— 55 18 



252 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

the various outfits for the total clothing program, since the bulkiest could not be 
used in certain crew positions. They formed an indispensable supplement to 
body-size measurements used by airplane and armament engineers; they warned 
the clothing designers of the limitations imposed by aircraft, and they indicated 
regions of the garment where bulk might be reduced. 

The initial turret investigation led, as already noted, to work on steel hel- 
mets and on bulk in flying clothing; a third avenue was toward parachutes for 
turret wear. Limited space had made it virtually impossible for gunners to 
wear parachutes over adequate clothing in some aircrew stations which offered 
the best opportunities for emergency escape. Expressly designed parachutes 
were solicited, tested in turrets by selected subject wearing various clothing 
outfits, and the results used to make further recommendations to the designers. 

The required sizes and range of adjustment for parachute harnesses were 
studied; work was planned on the integration of the one-man life raft with the 
parachute harness, and on the design of the life raft itself. 

Anthropometric data were applied to a number of projects on which con- 
siderable work was done but which will merely be listed in order to keep the 
present discussion within reasonable bounds. These projects included (i) 
location of earphone sockets on helmets, (2) special combat devices for pursuit 
pilots, and (3) a project stemming from work on clothing and only remotely 
anthropological, involving the design and location on outer garments of a 
tab for attachment of a clip at the juncture of the flyer's oxygen equipment 
with that of the ship. 

The background, history and operation of physical anthropology in the 
AAF have been briefly summarized. Initiated as a consequence of pressing 
military problems involving human dimensions, the basic procedure was an 
anthropometric survey of Army Air Forces flyers, several thousands of whom 
were measured. These measurements were applied to the selection of personnel 
and to the design and sizing of military aircraft and associated equipment, 
including gun-turrets, oxygen masks, flying clothing, and parachutes, with the 
aim of increasing the comfort, efficiency, visibility, and safety of flying personnel 
The AAF anthropological program served as a model in the organization of 
a similar project by the Armored Command, Army Ground Forces. 

Several trends characterized the AAF project: (1) There was a con- 
sistent transition from analysis and evaluation of existing items to original 
design of new equipment, exemplified in connection with cargo airplane seats, 
oxygen masks and clip tabs, and prone position harnesses. (2) The original 
problems extended into many fields related only through the human element. 
Turrets led to studies of clothing bulk, steel helmets, and parachutes; oxygen 



RESEARCH AND DEVELOPMENT 



253 



masks, to work on all head and facegear; clothing, to oxygen equipment; and 
size analyses of specific turrets, to safety engineering in general. This empha- 
sized that the designer of equipment for human use should begin with man 
himself rather than relegate him to the subordinate position in which he is 
too often found. (3) As a consequence, the physical anthropologist could occupy 
a central position as human engineer, as exemplified by the numerous liaison 
functions he came to perform in the Army Air Forces. For example, parachutes 
and gun-turrets had been designed separately ; so had goggles, oxygen masks and 
helmets; and so had flying clothing and oxygen equipment. Anthropologists 
initiated integration of all these sets of material. 

High Altitude Studies 

Physiological problems encountered at high altitudes had always received 
prominent attention in the Aero Medical Laboratory, and the elevated 
operating altitudes reached during World War II emphasized and accelerated 
work in this field. The Laboratory was fortunate in having a background of 
experience and facilities for investigations in this area, the need having been 
recognized quite early in its history, but it was not prepared to meet the many 
stringent requirements imposed by modern combat flying. In spite of this, 
difficulties were overcome, deficiencies remedied, equipment improved and 
operations made less hazardous. 

Contributions of the Aero Medical Laboratory in the field of high-altitude 
studies may be divided as follows: (1) development of oxygen equipment, 
(2) pressure breathing, (3) explosive decompression, and (4) thermal problems. 
(Although investigations of the effects of toxic gases and decompression sickness 
received attention from time to time, the contributions in these fields are not 
considered of sufficient importance to warrant a detailed discussion.) In the 
first of these major studies, the principles of respiratory physiology played a 
dominant role both in assisting in the design and evaluation of new types of 
oxygen dispensing equipment and in establishing rules of conduct in their use 
at high altitudes. 13 Likewise, in the fields of explosive decompression and 
thermal studies, basic physiological principles of circulation and respiration 
were heavily relied upon. 

Oxygen Equipment. At the beginning of World War II there were two 
general types of oxygen systems in combat aircraft. One was the low-pressure 
continuous flow system, which consisted principally of each oxygen cylinder 
being connected so that oxygen was supplied from a common filler valve and 
discharged into a common distribution line. The regulator in this system 



RESEARCH AND DEVELOPMENT 



255 




Simulates actual physical exertion of an airman in the sky, PFC. Asher J. Finkel, Chicago, pedals 
a wheel while wearing an oxygen mask. Lt. John T. Bonner, Rye Center, N. H., is checking the 
regulator to determine what mixture of oxygen and other gases is being given out by the apparatus, 
and to find out if the airman is getting enough oxygen from the present regulator. 



256 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 




Diasram of oxy$en mask. 



RESEARCH AND DEVELOPMENT 



257 



was the type A-9A, and the mask was the Type A-8, commonly described as 
the BLB rebreather mask. The other system was a high-pressure one, which 
used the A-8A regulator and removable high-pressure cylinders for charging. 

At about this time it became apparent, however, that the constant flow 
system was not adequate for combat operations. The reasons were: (1) mask 
freezing at low temperatures, (2) poor oxygen economy, and (3) insufficient 
flexibility of the system to prevent oxygen waste at low altitudes and to 
insure an adequate supply at high altitudes under conditions of activity* Similar 
observations had been made by the Germans, resulting in the development of 
the Auer demand regulator. Several of these regulators were obtained by 
Capt. Otis O. Benson, Jr., on his visit to England during the "Battle of Britain ' 
in 1941 and were forwarded to the Aero Medical Laboratory. They were 
received 20 June 1941, immediately subjected to a variety of tests, and finally 
turned over to the Pioneer Instrument Company and the Air Reduction Sales 
Company to serve as a basis for development of an American counterpart. 
This was successfully accomplished, and the demand regulators developed were 
of the diluter type resembling the German design only to the extent of 
using the venturi principle of dilution and the air mixture valve, which includes 
an aneroid for controlling the amount of air introduced at the different altitudes. 
The remainder of the regulator mechanism was of local origin. After a great 
deal of modification, the designs of both companies were standardized and 
identified as the Type A-12 regulator. 

At the same time, considerable attention was being devoted to the problem 
of mask design. The Committee on Aviation Medicine of the NDRC assigned 
one of its members, Dr. C. K. Drinker of the Harvard School of Public Health, 
the problem of designing a new type of demand mask based on criteria agreed 
upon by all interested organizations. In cooperation with the Acushnet Rubber 
Company of New Bedford, Massachusetts, a mask was developed by Mr. Frank 
Mauer and designated as the L-12. After subsequent revisions, it was standard- 
ized by the Air Corps as the A-10. Meanwhile, a parallel development of a 
demand oxygen mask was being carried out by the Ohio Chemical and Manu- 
facturing Company, based upon designs of Dr. Anthony H. Bulbulian of the 
Mayo Clinic. The first model of this mask was completed in October of 
1 941 and after the usual modifications, including an almost complete change 
during the latter part of 1943, was finally standardized as the A-14 in 1944. 
The design of demand oxygen masks turned out to be a physiological and 
mechanical problem of considerable complexity. The tight fit of the mask 
over the contours of the face appeared to be a critical factor in the design, 
and the compromise between this requirement and that of comfort was a 



258 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

constantly perplexing problem. The freezing of the mask at high altitudes 
required further revisions in the design, as did the method of suspension and 
necessary integration with helmet and goggles. In addition, mask accessories, 
such as the mask-to-regulator tubing and quick disconnect, presented further 
design problems, which caused delay during a period when time was of the 
utmost importance. 

Although revisions of the entire system were constantly being made, stand- 
ardization of a complete demand oxygen system for aircraft was accomplished 
during the latter part of 1941. At this time the "individually manifolded 
system" was announced. This arrangement reduced considerably the vulner- 
ability of the oxygen system in the aircraft, and especially the supply to stations, 
in that each station or group of stations was supplied from a designated source 
isolated from the remaining supply, each cylinder being check-valved so as to 
protect the source in the event one cylinder was shot out. All of the cylinders 
on the aircraft were connected only through a common filler line, so that the 
entire system could be charged through a single filler valve. 

During the period 1941-42 considerable attention was being devoted to 
the magnitude of oxygen pressure used in the systems. The old continuous 
flow experiment utilized a so-called "high pressure" of 1,800 pounds full and 
250 pounds empty, while the demand system employed "low pressure" oxygen 
(450 pounds full and 50 pounds empty). Although the disadvantages of 
the high-pressure system, i. e., shattering of the cylinders when hit by gunfire 
and difficulty of charging, were well known, development of equipment based 
on this pressure continued well into the fall of 1942. The reasons for this are 
rather obscure, but at any rate the problem was resolved completely during 
the fall of 1942, after firing tests conducted at the Aberdeen Proving Ground 
during August demonstrated conclusively their vulnerability to gunfire. 
Following this, development of high-pressure equipment was abandoned by the 
Army Air Forces. It should be noted, however, that neither the U. S. Navy 
nor the Royal Air Force abandoned their high-pressure suit, nor did the 
German Air Force. 

The first design of flow indicator was made in the latter part of 194 1 and 
consisted of a ball-type unit, Type A-i, resembling a rotameter. It was not 
too satisfactory because of corrosion and leakage. During the next year, 
blinker-operating Type A-2 indicator was developed and adapted for use in 
connection with the pioneer construction of the A-12 regulator. In the fall 
of 1942, however, the Type A-2 was radically changed and materially im- 
proved to accommodate the two types of A-12 regulator and was identified 
as the Type A-3 flow indicator. 



RESEARCH AND DEVELOPMENT 



259 



The original mask-to-regulator hose was of a corrugated construction 
reinforced with wire and was not very satisfactory because of too much rigidity 
and little elongation. This, however, was improved considerably in 1943, when 
the present design of hose was developed and standardized, permitting greater 
flexibility and more elongation. 

The first low-pressure shatterproof cylinders were approved in the latter 
part of 194 1 and were of the type G-i. During the next year, the Types A-4, 
D2, F-i, and tentatively, the F-2 were approved. All oxygen cylinders at this 
time were made of stainless steel and rendered shatterproof by the use of 
exterior strapping which sufficiently supported the stainless steel so as to with- 
stand the stress produced by impact and penetration of a .50 caliber projectile. 
A great improvement was made in 1943, when low-pressure cylinders were 
developed which were made of low-alloy steel and so fabricated that the exterior 
was eliminated and the cylinders were less affected by gunfire than the older 
stainless steel design of cylinder. The result of this development made possible 
greater production, a reduction in cost ranging from 60 to 90 percent of the 
cost of the stainless steel cylinder, and an improvement in over-all strength of 
the cylinder. 

To supply oxygen to all turrets of bomber aircraft, a swivel joint was 
needed, and this development was accomplished in 1943. This unit was 
entirely peculiar to the AAF and was especially designed for use with oxygen. 

The original demand oxygen low-pressure system in aircraft included 
hydraulic fittings and many of the practices used for the installation of hydraulic 
systems. Because of the many difficulties encountered, improvements were 
made which resulted in the use of a double flare to replace the single flare 
and in improved fittings and methods of plumbing. The double flare fitting 
was standardized for use in the oxygen system in 1943. Check valves, filler 
valves and coupling units were developed for the aircraft oxygen system and 
standardized for universal use in the demand system. 

The demand system, 14 as the name implied, consisted of low-pressure, 
shatterproof oxygen cylinders manifolded together, and used check valves and 
distribution lines, filler valves, Type A-12 regulators, pressure gage, pressure 
signal assembly, indicator lamp, and flow indicator. A filler valve also was 
provided for recharging the system. In addition, a portable recharger hose 
was required at each crew position in heavy bombardment aircraft for re- 
charging portable (walk-around) oxygen equipment from the oxygen system 
in the airplane. The system required the use of new equipment, namely the 
demand-type oxygen mask and the demand regulator. It provided the user 



260 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

with the proper amount of oxygen under all conditions up to an altitude of 
approximately 40,000 feet. 

The Type A-12 demand regulator was essentially a diaphragm-operated 
flow valve which supplied the flyer with the proper mixture of air and oxygen 
every time he inhaled, and shut off when he exhaled. The percentage of oxygen 
delivered to the user increased with altitude, becoming approximately 100 per- 
cent when the flyer reached 30,000 feet. Adjustments during flight were not 
required and the regulators were installed as permanent fixtures at each station 
in the plane. Operation of the regulator was fully automatic. Each time the 
user inhaled he applied a small degree of suction to the regulator. This suction 
was sufficient to deflect the diaphragm which was connected to a valve, thus 
causing the valve to open. Oxygen was supplied as long as inhalation con- 
tinued, and when suction was no longer applied a spring returned the diaphragm 
to its original position, shutting off the valve. Normal breathing was all that 
was required to operate the regulator. 

In addition to furnishing oxygen automatically on demand, the A-12 regu- 
lator mixed air with oxygen and supplied the proper mixture according to 
altitude. An aneroid control, similar to that found in altimeters, directed an 
air port and an oxygen port. At sea level, the air port was wide open and the 
oxygen port closed, but as altitude increased, the aneroid expanded, gradually 
closing the air port and increasing the percentage of oxygen. Finally, at an 
altitude of about 30,000 feet, the air port was completely closed and the oxygen 
port wide open, delivering 100 percent oxygen. 

For reasons of economy, it was essential that the regulator mix air with 
oxygen at lower altitudes. A flyer actually would use more oxygen from his 
supply at 10,000 feet than at 30,000 feet if he breathed pure oxygen at both 
altitudes because, although the volume inhaled at both altitudes is approximately 
the same, for the weight or density of that volume at 10,000 feet is approximately 
twice that at 30,000 feet. 

The Auto-Mix on the regulator controlled automatic mixing of air with 
oxygen. When the Auto-Mix was in the "ON" position, the regulator auto- 
matically mixed the proper amount of air with the oxygen at all altitudes. 
When the Auto-Mix was "OFF," the air port was shut off and no air could be 
taken into the regulator; hence, pure oxygen was delivered. Nevertheless, when 
the Auto-Mix was "OFF," the regulator was still a demand regulator as it auto- 
matically furnished the amount of pure oxygen required upon inhalation. 
When the Auto-Mix was "ON," the luminous spot on the handle lined up with 
a similar spot on the regulator. When the Auto-Mix was "OFF," the luminous 



RESEARCH AND DEVELOPMENT 



261 



spot on the handle was hidden. The normal position was "ON." When the 
Auto-Mix was "OFF," oxygen was wasted and the supply rapidly depleted. 

On some of the latest Type A-12 regulators, in an attempt to clarify the use 
of the controls, the wording of the Auto-Mix lever positions on the cover plate 
of the regulator was changed. The word "ON" was changed to NORMAL 
position at all times except: (1) on extended flights at altitudes of 30,000 feet or 
above, if the medical advice was to breathe pure oxygen on the ground before 
take-off and to use it all the way up as protection against bends; (2) for treat- 
ment of wounded men below 30,000 feet; (3) when 100 percent oxygen was 
needed as an aid in treating shock, or as protection against poison gas. 

The emergency valve on the regulator, when turned on, provided a con- 
tinuous flow of oxygen into the mask and was to be used only as an emergency 
device. It rapidly diminished the supply of oxygen, since the flow was con- 
tinuous and the oxygen not being used escaped through the outlet vented in the 
mask. Opening this valve, unless absolutely essential, was extremely wasteful 
and almost comparable to dumping. 

There were two types of flow indicators used with the A-12 regulator. 
The Type A-i flow indicator consisted of a ball in a transparent tube inserted 
directly in the oxygen supply line to the regulator. When oxygen flowed from 
the regulator, the ball rose in the glass tube. When the flow stopped, the ball 
slowly fell. The ball thus bounced up and down with breathing. When the 
EMERGENCY was on, the ball rose to the top and remained there as long as 
the flow continued. Originally this indicator was widely used but its produc- 
tion was discontinued in favor of the A-3. The Type A-3 indicator blinked 
opened and shut with each breathing cycle of the user. It operated by variation 
in pressure in the A-12 regulator which had a tap on the side to which the Type 
A-3 oxygen flow indicator was connected by means of tubing. When the 
EMERGENCY was on, the indicator did not blink. This indicator was 
standardized by early 1944 and was the only one in production. 

The pressure gauge and indicator lamp were mounted on the same panel 
as the flow indicator. 

The demand oxygen mask was of special type that required very special 
selection of size and test of fit It contained a flapper valve which remained 
closed during inhalation so that oxygen from the regulator might be taken. 
Upon exhalation, the valve opened, thus permitting the exhaled gases to exhaust. 
There were four types of demand masks, namely: the A-9, A-10, A- 10 revised, 
and A-14. The type A-9 mask was made in two sizes, short and long. The 
type A-10 mask was similar to the A-9 but of improved design. It was made in 
three sizes: small, standard and large. This mask could be recognized by the 



262 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

nose strap. The type A~io revised was made in four sizes: extra small, small, 
standard and large and identified by the letter stamped under the chin of 
the mask. It had a simplified type of suspension from the helmet and did not 
have a nose strap. The type A-14 mask was the latest and was made in three 
sizes: large, medium and small. It was developed as an improvement upon 
the A-10 revised mask and gradually replaced it. Either of two microphones, 
the T-42 (carbon) or the T-44 (magnetic), was used with any of the standard 
demand-type masks. 

It is interesting to note that despite the fact that the demand system was 
standardized during the latter part of 1941, production and installation were 
so retarded that this equipment did not get into aircraft until the spring of 

1943- 

For the purpose of a walk-around supply of oxygen, a straight demand 
regulator, Type A-13, was developed and placed in production during the early 
part of 1942. This was assembled to the Type A-4 cylinder and constituted 
the walk-around assembly. There were two designs of the straight demand 
regulator: that made by the Aro Equipment Company and that made 
by the Scott Aviation Corporation. Both designs were used as the standard 
walk-around unit. This original design was to supply a quantity of 100 percent 
oxygen sufficient for a short period of time, since it was considered at that 
time that this would be ample. In 1944 this walk-around assembly was 
changed to a Type A-15 diluter demand regulator and a Type A-6 cylinder, 
which gave approximately 30 minutes supply. 

In 1944 the pressure demand system was supplied to all photographic air- 
craft, and installations were made in the modification centers. About this 
time, the A-13 mask was approved, which incorporated the balanced exhalation 
valve, allowing for use at pressures above ambient and as high as 12 inches of 
water, mask pressure. This mask was subsequently adopted as the stand- 
ard pressure breathing mask, while the A-14 mask remained the standard 
for the straight demand system. For cargo and passenger type aircraft, the 
automatic continuous flow system was developed in 1941. This system incor- 
porated principally the Type A-10 regulator, which adjusted flow according to 
altitude and accomplished this by a variation in pressure on the input side of an 
orifice. The regulator was improved later and was subsequently identified as 
the Type A-11 regulator, having a sufficient capacity to satisfy the requirements 
of 15 inactive people. 

In 1941 a bailout assembly was provided, consisting of a small capacity cylinder 
and cylinder valve, and incorporating an orifice to which a hose was attached 



RESEARCH AND DEVELOPMENT 



263 



carrying a pipe stem. This apparatus was improved in 1943 by completely 
changing the design of valve to include a break-ofT nipple and a ceramic meter- 
ing orifice, which gave a better flow and extended the duration of supply. The 
hose leading from the valve carried a connection which, coupled to the fitting 
on the mask hose, provided the flow connection of the bailout unit to the mask. 

A mechanical warning device was designed in 1943 to provide some form 
of a visual indication of breathing failure caused by malfunction of equipment 
or inadvertent disconnection from the regulator. This apparatus was adapted 
for fighter installations as well as multiplace or heavy bombardment aircraft. 

At the beginning of the war, the supply of oxygen for breathing was 
limited to commercial installations. However, activity began immediately to 
obtain a portable generator, a type of generator that could be used in the field 
for supplying oxygen, principally for breathing. In 1942 a large procurement 
was made from a plant designed and developed by the Independent Engineering 
Company, OTallon, Illinois. During this same time, the Air Products Com- 
pany developed a portable unit, and a few of these plants were procured. 
Basically, both generators worked on the principle of liquefying air at high 
pressure, followed by rectification. The principal objection to the Independent 
plant was that it produced oxygen as a gas, which was then compressed by 
means of water-lubricated compressors and charged into cylinders. This gas 
compression was accomplished in the Air Products Plants, producers of liquid 
oxygen, by means of a liquid oxygen pump, and the field service tests showed 
that this latter plant was far more suitable for field operation than the Inde- 
pendent plant. The liquid oxygen plant had considerable usefulness because 
of the need for liquid oxygen as rocket fuel and the advantage of saving in 
weight and space accomplished by using it as a source of breathing oxygen in 
aircraft. 

In the matter of weight, the Independent plant weighed approximately 
39,000 pounds, whereas the Air Products plant weighed approximately 22,000 
pounds. The former produced about 500 cubic feet per hour of oxygen. 
Because of high anticipated requirements on individual aircraft, a small gen- 
erator was developed which could be installed in aircraft and operated on the 
principle of liquefying air at lower pressure and reducing necessary weight. 
A mechanical separator was used to remove carbon dioxide and moisture, 
eliminating the use of chemicals. This unit weighed approximately 450 
pounds in all and delivered from 125 to 150 cubic feet per hour. Tests proved 
that this plant was not adaptable for use because of the large amount of main- 
tenance required for the amount of oxygen produced. However, the principle 
developed was used in a large capacity generator, wherein the total weight 



264 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

of the generator was about 5,000 pounds and the production was approximately 
600 cubic feet per hour. 

A further requirement in supplying oxygen was that the oxygen must be 
dry. In order to determine the amount of moisture in oxygen, it was necessary to 
develop moisture indicators. The first unit was made available in 1942 and 
operated on the principle of unbalance of Wheatstone's bridge produced by 
moisture absorption of a filament treated with phosphoric acid. Since that 
time, considerable improvement has been made in the original instrument. 
In 1944 a dew point meter was developed, using refrigeration produced by the 
expansion of compressed carbon dioxide as the means of cooling a metal target, 
the idea being to freeze out the water in the form of a mist which could be 
readily observed. 

Because of the development being carried on in the Laboratory on gas 
control apparatus, a further responsibility was added in improving the in- 
flation units for sea rescue equipment. This assignment occurred in the latter 
part of 1943. Low temperature discharge of carbon dioxide was accomplished 
by drying the carbon dioxide and adding nitrogen to provide discharge gas 
pressure at low temperatures. Modifications were also made in the valves, 
manifolds and other control apparatus used in the gear for inducing complete 
discharge of carbon dioxide from the storage cylinder into the raft. With 
this equipment, it was possible to inflate rafts stored at temperatures as. low 
as — 65 0 F. and at sufficiently rapid rate for sea rescue purposes. To improve 
the installation of the large-size rafts in aircraft, a two-way pull valve was 
designed and adopted. For the one-man pack raft, the inflation gear was 
completely redesigned; a lever-type valve was developed and standardized in 
1944 to facilitate and insure operation. The check valve installed in the raft 
tube was made so as to securely seal off carbon dioxide within the raft to prevent 
loss of inflation. Inflation equipment for the life vest was materially modified 
in improving the inflator and cartridge used for storing carbon dioxide. In 
1944 a self-closing type of oral inflation valve was also designed and stand- 
ardized, which eliminated the loss of charge occurring in service through the 
manual type of oral valve used on the vests. The mounting of the inflator to 
the vest was improved and puncturing of the fabric was eliminated by 
modifying the metal plate that secured the inflator to the vest. 

In connection with the storage of carbon dioxide for sea rescue gear, an 
improved cylinder construction was developed which eliminated wire-winding 
to provide a shatterproof cylinder and made possible increased facilities for the 
manufacture of cylinders as well as substantially reducing the cost. These 
cylinders were also used for fire extinguishers. In connection with the develop- 



RESEARCH AND DEVELOPMENT 



265 



ment of cylinders, an air system was developed for the fuel supply on the "buzz" 
bomb. This involved the development of a large-size spherical cylinder about 
22 inches in diameter, withstanding a pressure of 2,000 psi, and a regulator 
and distribution system for supplying the required pressure on the fuel for 
transferring the fuel during flight. Cylinders were also developed for the 
nitrous oxide system which was used on aircraft engines for increasing power 
output, and designs were made also of an acid aniline system used on the P-51 
aircraft for increasing acceleration for short periods of time to make possible 
speeds equivalent to or greater than the jet aircraft of the Germans. 

A portable type of carbon dioxide generator was designed in the first part 
of 1944, the carbon dioxide being obtained by the burning of crankcase drainage 
from aircraft engines. This unit employed the principle of controlled combus- 
tion of fuel oil to generate carbon dioxide, which is recovered by selective 
absorption and compression and liquefaction of the gas. 

During this same period, requirements existed for a portable type of acety- 
lene generator for welding. In the early part of 1945, a 25-pound generator 
using carbide was developed. The reservoir was a 50-gallon AAF standard oil 
drum. Kits were to be made of a feeding and safety unit which could be 
mounted on a drum located in the area of use and provide an operative unit 
without shipping a bulky and heavy reservoir. 

Pressure Breathing, As stated earlier, the subject of pressure breathing 
will be considered here as a special topic. This is due to the novel principle of 
oxygen administration employed and the peculiar physiological problems 
resulting therefrom. It was, of course, clearly recognized that the demand 
system, as described above, had serious limitations at high altitudes. Even 
when breathing 100 percent oxygen, blood oxygen saturation began to fall off 
at around 33,000 feet and reached a dangerous level at 41,000 feet. With exer- 
cise, saturation fell more sharply, and this, together with possible mask leaks, 
lowered the absolute ceiling. Oxygen administration presented a serious 
drawback to high altitude operations, and an urgent military need existed for 
the development of equipment to enable aircrews to attain altitudes above those 
attainable with the demand system, without recourse to pressure cabins and 
pressure suits, and to serve as emergency equipment in pressure cabin aircraft. 

Realizing that the only way to keep blood oxygen saturation above 85 per 
cent at altitudes above 41,000 feet was to increase the oxygen pressure in the 
lungs, Capt A. P. Gagge during the latter part of 1941 began experimentation at 
high altitudes by administering pure oxygen at pressures of 15 to 25 mm. Hg 
(8 to 12 inches of water pressure) above the ambient pressure. The first 



266 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

experiment was carried out at 43,000 feet on 12 December 194 1 with Gagge 
as subject. The following is a description of the apparatus used: The subject 
wore a mouthpiece, similar to that used in a standard metabolism apparatus, 
which was fitted between the teeth and lips and held to the face by a Canadian 
type oro-nasal mask and straps. Rubber sponges placed between each side of 
the nose and the mask effectively sealed the oxygen leaks through the nose. 
The subject breathed from a closed circuit, consisting of a motor blower and a 
sodaline container to absorb the carbon dioxide exhaled. The tidal air of respira- 
tion was taken up in a large rubber spirometer. As the height of the respiration 
bellows lowered due to the absorbing of carbon dioxide, a cam attached to the 
bellows actuated a microswitch, causing the solenoid valve to the oxygen supply 
to open. Thus the oxygen used by the body in each breath was continuously 
and automatically replaced into the respiration system. The pressure in the 
oxygen system was varied by weighing the top of the rubber bellows spirometer. 
The arterial saturation maintained under these conditions was 84 percent, as 
compared with a control of 75 percent at ambient pressure. 

The success of this experiment stimulated further studies and additional 
favorable results added impetus to the program, which was thenceforth vigor- 
ously pursued. Simplification of the initial equipment was soon begun, and 
the design of a spring weighted A-12 demand regulator especially designed for 
pressure breathing was developed by the J. H. Emerson Company, Cambridge, 
Massachusetts, in June of 1942. Mechanical aids, such as a pneumatic vest to ease 
the respiratory effort, were tried during the summer of 1942, and, although 
proving helpful, were subsequently discarded, their impracticability outweigh- 
ing the slight assistance given. During this time constant revision and improve- 
ments were being made in both mask and regulator. In October of 1942, Capt. 
F. E. Randall began the development of a pressure breathing mask based on 
anthropometric facial measurements. The original models were made from 
plaster molds and were latex-dipped. This model was finally standardized as 
the A-13, and samples submitted to the Mine Safety Appliances Corporation 
for development as a production item. In October of 1943, the Ohio Chemical 
and Manufacturing Company initiated development of a pressure breathing 
mask, based on a design submitted by Dr. Bulbulian of the Mayo Clinic. This 
model was designated the A-15 but it was not accepted by the AAF Proving 
Ground Command. Meanwhile, Mr. B. B. Holmes of the Pioneer Instrument 
Division was reworking the Emerson regulator, and in January of 1943 
brought out an improved pressure demand regulator, which was subsequently 
standardized as the A-17. 



RESEARCH AND DEVELOPMENT 



267 



Concurrent with the development of equipment, laboratory and flight tests 
were being conducted. The key to the success of pressure breathing was the 
compensated exhalation valve which was originated by William Wildbock of 
Bureau of Standards while on visit to Wright Field in the spring 1943. The 
practical design was developed by Lunde Oxygen Company. In November 
of 1942, Lt. Col. W. R. Lovelace, with Boeing pilot A. C. Reed and co-pilot 
J. A. Frazer, made the first aircraft flight with pressure breathing equipment 
in a B-17E aircraft to an indicated altitude of 42,000 feet. The Emerson 
regulator was used with a Randall Laboratory-made mask. In April 1943, he 
made another flight in a P-38, with Lockheed pilot Joe Towle, to 44,980 feet, 
using this equipment. In this flight the Holmes A-17 was used. With this 
regulator the pilot exhaled through the mask exhalation valve. 

Late in 1943 the possibility of using pressure breathing equipment in high 
altitude missions came to the attention of photographic reconnaissance groups, 
and administrative details were completed for the operation training of these 
squadrons. From 26 October to 6 November 1943 pilots of the 28th Photo 
Reconnaissance Squadron were the first group to be so trained and equipped 
at Wright Field. Later in November pressure breathing was adopted for photo 
reconnaissance use in the AAF and purchase authorized for 4,000 sets of equip- 
ment. This equipment consisted of a Mine Safety Manufactured A-13 fitted 
with compensated exhalation valves and of the Arotype A-14 pressure demand 
regulators. The early sets of the A-14 use ^ the Holmes A-17 chest-mounted 
regulators with Lunde mask valve. A reducing valve was used at the aircrew 
station. In February of 1944 the first operational mission using pressure breath- 
ing equipment was carried out by the 14th Photo Reconnaissance Squadron 
and in April this equipment was used over Berlin for the first time. This 
squadron used Spitfires, not P-38's, but was manned by Air Corps personnel. 
By November of 1944 all new F-5 and F-13 aircraft were equipped with A-14 
regulators and the pilots trained at Will Rogers and Salina Fields. Early in 
November of that year pressure breathing was in use over Tokyo. 

Explosive Decompression^ The principal operational hazard in cabin 
pressurization was the effect of sudden loss in cabin pressure on aircrews. 
Decompression at a rate greater than 5,000 feet per minute was considered by 
Armstrong to be "explosive." The first to recognize this as one of the most 
important physiologic problems in the use of the pressure cabin, he coined the 
term "explosive decompression." In 1935 Armstrong made the first free fall 
with delayed parachute opening. In the years from 1935 to 1942, he, Dill, 
Smith, and others subjected animals and human beings to explosive decom- 
pression. Decompressions of the fastest rate were performed on animals by 

262297°— 55 19 



RESEARCH AND DEVELOPMENT 



269 



KNOW YOUR PRESSURE CABIN! 




CABIN PRESSURE REGULATOR 
Allows proper air outflow ' -'.r-*r 

to maintain desired cabin pressure^' 



EMERGENCY 
DUMP VALVE 



NEGATIVE PRESSURE RELIEF VALVE 
to prevent OUTSIDE presiure from 
appreciably exceeding CABIN 
pressure, as in a HIGH SPEED DIVE 



{RELEASES PRESSURE SO DOORS MAY BE OPENED.) 

I : w 




bail out but cabin \ 
pressure keeps door shut J 



bombers open INWARD!. 



Chart 7. Pressure cabin. 



600 MPH 
1612 YDS. 




Chart 8. Radius of aircraft turn required to blackout average pilot at various true air speeds. 



270 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 




Chart 9. Speed a plane must make a pull 2 to 8 G*s on a flisht path of 700 yard radius. 




RADIUS OF TURN IN YARDS 



Chart 10. - , G U force resulting from varying radius of turn with constant speed. 



RESEARCH AND DEVELOPMENT 



271 



Smith in 1942. He subjected rabbits, rats, and dogs to explosive decompres- 
sion at rates equivalent to ascents of 1,942,000 feet per second (from an initial 
level of 8,000 feet to a final level of 45,000 feet in 0.019 second). The gas 
expanded to 8.1 times its original volume, and as a result, 3 of 6 rabbits were 
killed. Neither dogs nor rats succumbed, although partial collapse and hemor- 
rhage occurred in the lungs of rats, and hemorrhage of the middle ears was 
found in dogs. 

The most rapid ascent for human beings during this period was accom- 
plished by Armstrong, who subjected five persons to 26 decompressions at the 
rate of 160,000 feet per second. Expansion of body gases was 1.8 times, and 
in no case was either injury or undue discomfort shown by any subject. Con- 
trary to expectations it was found that ear discomfort on ascent was less at 
the higher rates than at the lower, possibly because Eustachian tubes were blown 
open immediately and remained open during the whole pressure change. In 
normal flight the Eustachian tube "clicks" open and shut at intervals during 
ascent, causing discomfort. 

In 194 1 Dill found human subjects capable of ascending 40,000 feet in 2 
minutes and 45 seconds and remaining there for 5 minutes with no symptoms 
other than those from gastro-intestinal gas cramps. Smith also performed 
decompressions on human subjects by taking them from 10,000 feet to 40,000 
feet altitude at the rate of 20,000 feet per second. The degree of explosive 
decompression which one could withstand safely was determined by either the 
extent or the rate of expansion of internal body gases. The hollow organs 
considered were the stomach, intestines, and lungs. 

During ordinary ascents in flight, expansion of the air in the lungs never 
built up an appreciable pressure because the trachea afforded an adequate passage 
for equalization. In the gastro-intestinal tract the excess volume of gas was 
usually expelled before the pressure produced serious distension. In going from 
sea level to 40,000 feet the wet body gases theoretically increased in volume 7.6 
times, an excess over the original amounting to 6.6 volumes. Although the 
capacity of the lungs could be doubled, 5.6 volumes of gas remained to be 
expelled. If decompression took place in 0.1 second, a volume of air 5.6 times 
the original must be expelled during this brief period or stretch the lungs beyond 
physiologic limits. 

In the above example, the rate of gas expansion was 66 volumes per second. 
The effect of explosive decompression on the body could be determined by the 
rate of expansion alone. With high expansion rates, in which there was inade- 
quate time for expanding gases to escape through the trachea or to be expelled 
from the gastro-intestinal tract, the actual amount of expansion became an 



272 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

additional factor. For example, if the volume of air was not more than doubled 
by expansion, subjective respiratory sensations were not aroused even though 
the expansion rate was extremely high. This was due to the fact that the lungs 
could easily double their capacity without undue stretching. 

There was a potential danger when the expansion rate approached that of 
instantaneous decompression, even if only a small expansion was involved. 
For elastic tissue to elongate, a change of the shape of individual cells occurred 
which required time. If the decompression was sufficiently brief, it was possible 
to damage the tissues because of the inability of the cells to overcome internal 
resistance rapidly enough. Four physical factors were involved in explosive 
decompression : 16 

1 . The volume of the pressurized compartment (cu. ft.). 

2. The size of the opening (diameter in inches). 

3. The pressure differential (psi). 

4. The flight altitude at which decompression took place (feet). 

The first three regulated the time or duration of decompression. With the 
time accurately measured and the pressure differential known, the rate of 
decompression could be determined in psi per second. The last two factors 
listed regulated the extent of expansion of the internal body gases, and 
from this figure, with the time of decompression, the expansion rate could be 
determined. 

The smaller the volume of the pressurized compartment or the larger the 
opening, the shorter was the time of decompression. When other factors 
were constant, an increase in the pressure differential extended the time of 
decompression, but the decompression rate and expansion rate were also 
increased. The most drastic decompression possible would be that occurring 
in the smallest cabin, when it was struck by a missile which instantly disin- 
tegrated the entire cabin. 

In March 1943 the Aero Medical Laboratory was asked by the Technical 
Staff, Engineering Division, Materiel Command, to state the requirements 
for pressurization of fighter and bomber aircraft which would reduce the 
hazard of explosive decompression to a minimum. On the meager evidence 
at hand, it was recommended that the fuselage be stressed and pressurizing 
equipment be built for a 6.55 psi differential in bombers and for a 2.75 psi 
differential pressure in fighter aircraft. The former differential was sufficient 
to allow ascents as high as 35,000 feet without oxygen equipment, while the 
latter would keep the cabin altitude below "bends level" (30,000 feet) in flights 
up to 50,000 feet actual altitude. 



RESEARCH AND DEVELOPMENT 



273 



Experiments were initiated under the direction of Maj. H. M. Sweeney 
(MC) to evaluate the tolerance of flyers to explosive decompression and the 
magnitude likely to occur under these conditions. The first of these experi- 
ments was performed with one experimental pressure suit in an altitude cham- 
ber during May of 1943. Since the volume of the suit was but a few cubic feet, 
the opening comparable to the largest hole in a plane likely to result from enemy 
gunfire needed to be only a few inches in diameter. Since the pressure suit was 
difficult to don and was not constructed to withstand a 6,55 psi differential pres- 
sure, a mock-up of a P-38 cabin was borrowed from Lockheed Aeronautical 
Corporation. In the fore end of the mock-up an entrance with a removable door 
was made. To provide exploding openings of various sizes, several interchange- 
able doors were made with apertures of different sizes. The cabin was 
equipped with demand and pressure oxygen systems, a communication system, 
and a time-pressure recorder designed to an accurate time tracing of the rapid 
changes. The cabin was placed in a decompression chamber; the subject 
entered it, and a simulated flight was begun. When the desired pressure 
cabin altitude was reached, the opening was sealed. The chamber continued to 
the desired flight altitude, and explosive decompression was accomplished by 
puncturing the paper seal, which disintegrated. Air rushed out of the mock-up 
cabin until the pressure was equalized with that of the simulated flight. 

During the fall of 1943 the first tests on human subjects were gradually 
intensified by increasing the size of the exploding opening, the pressure differ- 
ential, and the altitudes. Before and after each new stop, roentgenograms of 
the lungs were made, and even vital capacity of the lungs was measured in an 
effort to reveal any injury resulting from the experience. The rationale of the 
latter procedure was that any multiple, minute contusions and resulting edema 
in the lungs would decrease the lung capacity. Subjects waited several days 
between more drastic tests to determine possible latent reactions. 

No ill effects were detected, and the subjects had no latent symptoms. The 
effects of explosive decompression on the subjects were all comparable. At the 
moment of decompression the subject experienced a sense of inflation in the 
chest and abdomen as a result of expanded gas. The subject coughed or sneezed 
as air rushed out of the mouth and nose. The observer could see the subject's 
chest and abdomen expand rapidly. This was verified by moving pictures. 
With the more drastic decompressions, a few subjects felt twinges of pain in 
the upper abdominal region, possibly a result of stretching of the attachments 
of the diaphragm. One subject felt moderate pain in the umbilical region. 
These subjects may have had excessive gas in the gastro-intestinal tract, but 
roentgenographic studies after ingestion of barium failed to show any correla- 



274 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

tion between the amount of gas and the incidence of pain. With the more 
intense decompressions, subjects were dazed momentarily but always remained 
conscious. They were able to put on their oxygen masks and unscrew the bolts 
on the cabin door, a fair indication that a pilot would be able to fly his plane to 
a safer level if his pressure cabin suddenly leaked. 

About 20 percent of subjects decompressed to altitudes above 40,000 feet suf- 
fered bends during the ensuing five minutes at altitude. Had they been pilots, 
however, they would have had time to fly their airplanes to lower altitudes. 

In order to obtain information on the size of openings resulting from gun- 
fire in pressurized airplanes, firing tests were conducted on the XB-32 and 
XB-29 during the summer of 1943. The most vulnerable spots were pierced 
with .50 caliber and 20 mm. high explosive bullets. The largest openings ob- 
tained were from disintegration of scanning blisters, about 30 inches in diameter. 

Explosive decompression was first done at an altitude of 45,000 feet, using 
a 2.75 psi differential pressure, and an opening equivalent to one of 18 inches 
in a fighter airplane. In the next tests, 47 subjects, 14 of whom were flight 
surgeons of the XX Bomber Command, were used for a total of 100 tests. 
Since then, 50 more tests of the same type were made. Decompressions were at 
35,000 feet with a 6.55 psi differential pressure (cabin altitude of 10,200 feet), 
an exploding opening equivalent to a 66-inch opening in a fuselage of 1,000 
cubic feet capacity. This was a larger opening than any produced experi- 
mentally or reported from enemy gunfire. These decompressions took place in 
0.075 second, giving a decompression rate of 87 psi per second. The expansion 
of internal body gases amounted to an increase of 3.5 times. Later decompres- 
sions at 35,000 feet with a 7.5 psi differential pressure (cabin altitude 8,000 feet) 
were well tolerated by human subjects. These experiments proved that differ- 
ential pressures as high as 7.5 psi were safe for current large volume heavy 
bombardment aircraft, even when flying through enemy gunfire. There were 
three cases of injury at the Aero Medical Laboratory as a result of explosive 
decompression. 

With the advent of the bubble type canopy on fighter aircraft, a new prob- 
lem of explosive decompression arose. Since bubble canopies were similar to 
scanning blisters on bombers, it was considered probable that they too would 
disintegrate when struck by a 20 mm. projectile. In one new airplane this 
potential explosive opening was 27 inches in diameter. Early experiments re- 
vealed that explosive decompression with an 18-inch opening in a 45-cubic foot 
cabin at 45,000 feet using a 2.75 psi differential pressure, approached the limit 
of human tolerance. Explosive decompressions were performed to determine if 
at 50,000 feet a 1.0 psi differential pressure could be withstood safely when an 



RESEARCH AND DEVELOPMENT 



275 



opening of 27 inches was made. One psi differential was sufficient to reduce the 
cabin altitude of an airplane flying at 50,000 feet to 40,000 feet where anoxia 
would not be a problem if subjects used pressure demand oxygen equipment 
and safety pressure of 1 to 2 inches of water. 

Decompression at 45,000 feet with 1.5 psi differential and at 50,000 feet 
with 1.0 psi differential pressure was tolerated by the subjects. At the higher 
altitude there was some difficulty in properly adjusting the pressure breathing 
regulator to ward off anoxia. It was considered imperative that all personnel 
flying to altitudes above 40,000 feet be well indoctrinated in the use of pressure 
breathing equipment. Twenty percent of the subjects experienced bends' of 
rapid onset following decompression. Ways of reducing the size of the metallic 
opening in the cockpit or means to prevent disintegration of the whole canopy 
appeared as solutions. Either would allow an increase in the differential pres- 
sure great enough to protect against bends. 

The above type of experimentation represented a clear-cut example of the 
manner in which human requirements for aircraft design and operation were 
determined and evaluated at the Aero Medical Laboratory. The problem then 
remained to translate this human data into mechanical data, formulas, graphs, 
tables and charts which would be intelligible to the design engineer. In the 
case of explosive decompression, this was accomplished by Lt. Col. A. P. Gagge 
and presented in a report 17 which described an analytical method especially 
suitable for engineers and designers in evaluating the possible danger of explo- 
sive decompression in various types of pressurized aircraft. 

Thermal Studies. The severity and diversity of atmospheric conditions 
encountered by airplanes in military operations created problems in physiologi- 
cal adaptation and engineering hitherto unknown. The rate of exposure and 
range of ambient temperature, wind movement, vapor pressure and solar energy 
to which flying personnel were subjected far exceeded the experimental range 
previously explored. Consequently, studies were initiated at the Aero Medical 
Laboratory during 1942 to find solutions to some of the more pressing problems 
of tliis nature. 

Studies of the effective insulation of Army Air Forces flying clothing were 
initiated in early 1942 by Capt. A. P. Gagge, who in April of 1942 visited Hawaii 
to investigate the general aspects of clothing problems and needs in the Pacific 
Theater. In the same year Mr. H. B. Washburn was engaged as consultant 
and reported on results of Alaskan tests designed to select clothing items or 
articles of special value to the Army Air Forces in the air or on the ground. 

Shortly after this a clothing test unit was established in the Biophysics 



276 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

Branch of the Aero Medical Laboratory under the direction of Lt. Col. Craig 
L. Taylor. The broad objectives of the unit were to determine the tolerance 
ranges and means of protecting personnel in both hot and cold environments, 
so as to insure maximum efficiency under these respective conditions. 

Emphasis during the early part of the unit's existence was focused upon 
cold weather clothing since with the increasing numbers of B-17's bombing 
Germany, the problem of keeping various crew members, such as bombardiers, 
pilots and navigators, warm and effectively functioning assumed paramount 
importance for the successful conduct of the war. With high altitude flights 
of relatively long duration occurring almost daily and with ambient tempera- 
tures around — 50 0 or —60 0 F., the interior temperature of bombing planes and 
fighter escort reached 0 to — 10 0 F. or even lower in exposed crew positions. The 
need for individual heating suits became obvious, and the AAF, in conjunction 
with the Pioneer Products Division of General Electric Company, developed an 
electrically heated suit to help solve the problem. The early (F-i) models 
were poorly designed from the standpoint of proper heat distribution (some 
body parts burning, others cooling), and since they were wired in series, a break 
in gloves or boots resulted in a completely ineffective suit. 

In October 1943, however, the improved F-2 (GE model) electrically 
heated suit came into production. It was greatly improved as to fit, weight 
and heat distribution, and it was wired in parallel so that breakage in one glove 
or boot did not destroy the entire suit's usefulness. Extensive tests of this type 
of suit, as well as other models, were conducted at various simulated altitudes 
in the refrigerated altitude chamber and at ground level in the all-weather room 
of the Aero Medical Laboratory to evaluate practically the useful temperature 
range, efficiency and effective insulation of these suits. Flight tests were also 
carried out, and, in cooperation with the Personal Equipment Laboratory, field 
service and functional tests were included. 

Among the special problems arising during this period of investigation 
may be mentioned those of (1) adequate heated and non-heated handgear, (2) 
heated and non-heated footgear, (3) protection of eyes and face from cold wind 
blasts, and (4) usefulness of extremity heated assemblies for P-38 pilots. 

The feet, and especially the hands, of aircraft personnel were essential in 
the performance of their duties, and adequate protection was required. How- 
ever, both hands and feet were especially susceptible to the cold since they had 
large areas with small masses, their circulation was limited by cold, and they 
often were in contact with objects which conducted away their heat. Thus, 
the problems involved were many. Tests of many types of both non-heated and 



RESEARCH AND DEVELOPMENT 



277 



electrically heated gloves were conducted, and a series of four conferences on 
handgear was held during the period of October 1943 to February 1944. The 
third of these, held 20 December 1943 at the Aero Medical Laboratory, was 
concerned with topics such as (1) dexterity tests for gloves, (2) methods of 
analysis of tests for handgear, and (3) glove design. Among the general results 
attained as a result of these meetings were (1) the formulation of a relatively 
standardized testing procedure for handgear which specified use of artifical 
(copper) models, (2) tolerance time and grading of sensation, (3) dexterity tests, 
and (4) a standard method for obtaining the average skin temperature of the 
hands. 

The Aleutian area and English Channel focused attention upon the 
need for a flying exposure suit designed to protect flying personnel from the 
serious hazard of emergency exposure to cold water. In collaboration with the 
Personal Equipment Laboratory, tests of several models of this type suit were 
made. Several conferences, attended by various civilian and service representa- 
tives, were held in 1944 at the Aero Medical Laboratory to summarize results 
and to direct subsequent efforts on this aspect of protective clothing. The first of 
these was held 4 January 1944. As a result of this and other meetings, the 
function of the emergency exposure suit was divided into two categories: (a) as 
a protective garment against salt water, rain, cold, and wind; and (b) as protec- 
tion against the sun. In category (a) the suit had to be light-weight, one-piece, 
water-tight with attached feet and gloves, and large enough to fit over ordinary 
clothing. Such a garment could be used as protection against cold, wind, rain, 
spray, and as flotation if a life raft capsized. In category (b) a light-weight, 
porous, loose-fitting, one-piece suit with hood or wide-brim hat was needed. 
It was observed that when rubberized or water-proofed material was used on the 
outer garment, the body could not perspire freely, and in warm conditions such 
a suit was quite uncomfortable. Under sub-freezing conditions, the suit became 
hazardous since water froze within and thus reduced the suit's insulation. 

Through the efforts of the Physiological Laboratory, Farnsborough, Eng- 
land, a suit permeable to water vapor but impermeable to water itself was 
developed. This was the "Paaske" suit and the type cloth was eventually used 
by the A AF in various exposure suit types. 

By late 1945 a further improved model of the F-2 electrically heated flying 
suit (the F-3) was available to the AAF. It made possible exposure to ambient 
temperatures as low as — 6o° F. for relatively long periods, provided some 
supplementary hand and foot insulation was available. 

With the advent of the long range bomber— for example, the B-17 and B- 
29 — another problem of concern arose: the care of injured or wounded aircraft 



278 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

personnel who had to be protected from cold or shock as far as possible until the 
return of the plane to its base. To meet this need, an electrically heated and 
thermostatically controlled casualty blanket was designed. Tests of the func- 
tional adequacy of various types were carried out in late 1944 and recommenda- 
tions for improvement submitted. For use with this blanket, as well as with 
the electrically heated flying suit, the GE Company designed an ambient control 
switch, permitting more effective control of electrical input in relation to ambient 
temperature. 

The comparison of the insulation values of complete clothing assemblies, 
handgear, footgear and headgear was greatly facilitated by the use of electrically 
heated copper manikins constructed for the Aero Medical Laboratory by the 
GE Company. These instruments permitted precise measurement of the insu- 
lation value of clothing assemblies or items and the expression of results in 
quantitative terms or "clo" units. Small differences in insulation between 
gloves, for example, could be reliably determined with this method, conse- 
quently resulting in the elimination of considerable human subject testing with 
its unavoidable and complicated physiological variation. Routine test proced- 
ures for the evaluation of the insulation of both heated and non-heated clothing 
assemblies, headgear, footgear and handgear were devised and were success- 
fully practiced. 

The defeat of Germany and the shift of attention from the European to the 
Pacific Theater brought forth several new problems relating to thermal research. 
One of these was the demand for cooler, wind-permeable clothing for ground 
crews; there was also the need for establishing definite aircraft cabin comfort 
requirements. Efforts were directed toward evaluating the total thermal stress 
from known ambient conditions and correlating this with the physiological 
response. As a result of a large series of experiments performed at the Aero 
Medical Laboratory, the maximum, minimum and comfort levels at various 
ambient temperatures were outlined and the time-tolerance curves plotted. 
On the basis of this work the requirements for aircraft cabins in regard to 
heating, cooling and ventilation were specified. The design of both conven- 
tional and non-conventional aircraft was assisted by these data. 

Parachute Opening ShocJ^ As the war progressed, the frequency of 
parachute escape at high altitudes increased and reports reaching the Command 
indicated that unusual hazards attended this procedure. Aside from the 
dangers of extreme cold, anoxia, and vulnerability to gun fire during descent, 
some reports suggested that the impact of parachute opening at high altitudes 
might be too severe to be safely borne by the human organism. It appeared 



RESEARCH AND DEVELOPMENT 



279 



probable that the records received would represent a small percentage of the 
total, since appreciable numbers of flying personnel escaping at high altitudes 
landed in enemy territory under unreported circumstances. Inasmuch as data 
concerning the behavior of the parachute at high altitudes had been lacking, 
and ideas about the magnitude and duration of the opening shock at high 
altitudes had been the product of theory, tests were devised to study these 
phenomena of parachuting. The existence of this force was first demonstrated 
in the high altitude bail-out of W. R. Lovelace from 40,000 feet (static line 
opening) in June 1943. The shock knocked off his glove resulting in severe 
frost bite of his right hand. This observation of Lovelace was one of the most 
important contributions coming out of the Laboratory in those early years. As 
a result of Lovelace's experience the following test program was speeded up. 

To measure the magnitude and duration of these forces, during the fall of 
1943, a recording tensionometer was developed by Mr. Bertyl H. T, Lindquist 
and Professor James J. Ryan of the University of Minnesota. This device could 
be used for the measurement of any forces due to static or dynamic loads up to 
10,000 pounds. 

The experiments were carried out at Muroc Army Air Field during the 
winter of 1944 by the Aero Medical and Personal Equipment Laboratories with 
the cooperation of Lindquist, Ryan and also Dr. E. J. Baldes of the Mayo Clinic. 

Standard nylon B-8 back type parachutes with 24-foot canopies were used 
in this study. Dummies were dropped from the bomb bay of a B-17-E aircraft. 
Ripcords were pulled by static lines which were 25 feet in length. Descent 
times were obtained from 200-pound dummies with 24-foot canopies from 
density altitudes of 7,000, 15,000, 26,000, 33,000, 35,000, and 40,000 feet. The 
experimentally determined points were found to fit a curve calculated on the 
basis of a rate of descent of 25 feet per second at sea level. No actual measure- 
ments of landing velocity were made. 

The force-time curve developed during parachute openings consisted of an 
initial impact followed by a rise in an undulating fashion to a final peak, after 
which the force declined to that represented by an acceleration of iG. The 
duration of the impact, defined as the time from the first recorded impact to a 
return of an acceleration of iG, was essentially unaffected by changes in air 
density (altitude) or air speed. The mean duration of 148 openings was 1.45 
seconds with a standard deviation of 0.61. However, the greater the magnitude 
of the final peak, the shorter was the time interval between the initial impact and 
the final peak. 



RESEARCH AND DEVELOPMENT 



281 



A summary of data on the magnitude of parachute opening shock forces is 
as follows: 

1. Drops were made: 

(a) With horizontal launching velocity constant while air density was 
varied: Two-hundred-pound dummies with 24-foot canopies were dropped at a 
launching speed of 232 m. p. h. (340.3 feet per second true air speed) from 
density altitudes of 3,000, 7,000, 15,000, 20,000, 26,000, 33,000 and 40,000 feet. 
Two hundred and thirty-two miles per hour true air speed was in the range of 
terminal velocity of man in free fall at 40,000 feet. The mean final peak forces 
were 2,300, 2,400, 3,300, 5,300, 5,800, and 6,600 pounds, respectively. Thus the 
final peak forces progressed from an acceleration of approximately 12 G at 3,000 
and 7,000 feet density altitude to one of 33 G at 40,000 feet density altitude. 

(b) With horizontal launching velocity varied while air density was con- 
stant: As was to be expected, increasing the launching velocity at a given air 
density was found to increase the force expressed on the dummies during para- 
chute openings. The data indicated that the increase in load per mile per hour 
increase in launching velocity was greater at 26,000 feet than at 3,000 or 15,000 
feet density altitude. 

2. Data presented above were regrouped as follows : 



Density altitude 


Horizontal launching 
speed 


Force, final peak 


I.A.S 


T.A.S 


Pounds 


G 


7,000 


119 


128 


1, 700 


8.5 


15,000 


119 


146 


1, 900 


9.5 


26,000 


119 


175 


2, 800 


14.0 


40,000 


119 


232 


6, 600 


33.0 



The horizontal launching speeds were calculated terminal velocities for man 
in free fall at each altitude. These data were interpreted as approximately the 
forces which would be expressed on a man falling at terminal velocity if he 
opened his parachute at these altitudes. The tremendous increase in force 
developed at high altitude was evident. 

3. The forces imposed on 145-pound dummies were higher than those 
developed when 200-pound dummies were dropped. 



282 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

4. Parachute opening shock forces expressed on a St. Bernard dog, weighing 
145 pounds, were compared with those recorded when hard rubber dummies 
of the same weight were dropped. The character of the force-time curves and 
the magnitude and duration of the forces were essentially the same. It was 
concluded that data obtained from hard rubber dummies could be transferred 
with validity to living bodies. 

5. Standard parachute harnesses showed evidence of failure when exposed 
to the large forces encountered in these experiments. 

Conclusions reached in this study were: 
1. Descent time data for 200-pound dummies with 24-foot nylon canopies 
fit a calculated rate of descent curve based on a velocity of 25 feet per second 
at sea level. These data do not provide information regarding actual landing 
velocity. 

2. The total duration of parachute opening shocks was unaffected by 
altitude up to 40,000 feet and true air speeds up to 232 m. p. h., and occurred in 
the range of one to two seconds. 

3. As the magnitude of force increased, the time from the beginning of 
impact to the final peak decreased. 

4. The magnitude of the parachute opening shock was greater at higher 
altitudes than at lower altitudes: 

(a) When the horizontal launching speed was constant at all altitudes. 

(b) When the horizontal launching speed varied and was the calculated 
terminal velocity of a falling man at each altitude. 

5. When the horizontal launching speed of the dummies was increased 
at a given density altitude, the magnitude of the force at opening was increased. 
The increase in force per mile per hour in launching speed was greater at 26,000 
feet than at 7,000 or 15,000 feet. 

During the early part of 1944 it became apparent that descent from high 
altitude with the open parachute presented the hazards of anoxia, extreme cold, 
increased shock at parachute inflation, and vulnerability of gun fire during 
descent. These dangers made free fall a desirable alternative to immediate 
parachute inflation in high altitude jumps. The chief hazard of free fall was 
that of failure to pull the ripcord due to injury, hemorrhage, and anoxia. For 
these reasons it was felt that a satisfactory automatic parachute opening device 
would safely decelerate even unconscious personnel. 

Accordingly, a device of this nature was designed for the A-3 chest-type 
parachute and manufactured by the Friez Instrument Corporation. The entire 
unit was mounted in a canvas pocket at the end of the parachute casing near 



RESEARCH AND DEVELOPMENT 



283 



the ripcord. A temperature-compensated aneroid unit controlled a micro- 
switch which closed an electrical unit at a predetermined air pressure, firing a 
powder charge in a piston and cylinder unit. Movement of the piston within 
the cylinder activated an auxiliary cable, which pulled the ripcord. The same 
ripcord could be pulled either manually or by the device. A manually operated 
switch permitted the device to be inactivated when opening was not desired 
at altitudes where pressure was greater than that for which the aneroid-controlled • 
microswitch was set. 

Dummy drops from altitudes as high as 15,000 feet demonstrated that the 
device operated satisfactorily. 

Acceleration 

Although a number of fundamental observations on the physiological re- 
actions of the body to the forces of acceleration encountered during flight were 
made during the war years, the principal activity of the group working in this 
field was concerned with the development and evaluation of the anti-G suit. 
In view of this the following discussion will be limited to this activity. In so 
doing, the material in a report 18 by Maj. George A. Hallenbeck will be closely 
followed. 

Inasmuch as the development of anti-G devices was the result of the coopera- 
tive endeavor of a number of interested laboratories, it appears wise to treat the 
subject in its entirety, mentioning the contributions of the Aero Medical Labora- 
tory in their proper places. Anti-G suits thus far developed could be classified 
as hydrodynamic or pneumodynamic according to the source of pressure 
employed. The best developed water suit will be described first, and after it, 
a series of air suits. 

Workers in the field of acceleration had long realized that one method of 
opposing the downward displacement of blood during exposure to a positive G 
was to surround the pilot's body with a fluid so arranged that the increased 
pressure which was developed throughout the liquid when the liquid mass 
was exposed to increased G was transmitted to the body surface. Such a liquid 
column provided a perfect gradient pressure, with highest pressure deep in the 
fluid at foot level and lowest pressure at the surface at chest level. The actual 
pressure at any level depended on the magnitude of the G and on the specific 
gravity of the liquid. 

The problem of making a water suit was undertaken by Wing Commander 
W. R. Franks, RCAF, and his associates, who, after a great deal of study, de- 

262297°— 55 20 



284 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 




Pressure suits. 



RESEARCH AND DEVELOPMENT 



285 



veloped the Franks Flying Suit (FFS). The following brief description of the 
device was written by Franks in 1941 : 

An intercommunicating fluid system, encased in rubber units, is interposed between 
the body surface and a close fitting garment made of non-extensible yet flexible fabric. 
During a maneuver a hydrostatic pressure is brought to bear on the surface of the body, 
which automatically equalizes the internal pressure built up in the fluids of the body by 
the accelerating force. Former experience in aircraft showed that a considerable degree of 
protection was obtained by covering the body hydrostatically from the level of the heart 
down. The return blood supply to the heart is then assisted and the blood flow to the brain 
can be maintained at higher accelerations than otherwise. The shoulders and arms are con- 
sequently left free in the present suit. The fluid contained units do not cover the whole body, 
but are placed in certain areas only, in contrast to the outer fabric, which is completely below 
heart level. Areas not covered (by fluid containing units) receive their protection auto- 
matically from tension built up in the outer fabric by hydrostatic pressure in the fluid units 
of the parts covered. 

The protection afforded by the FFS on the centrifuge was determined by 
the Canadian group at Toronto and by the Mayo group at Rochester, Minnesota. 
The method employed compared blackout thresholds of subjects with and with- 
out the suit. In the two series, the blackout threshold was elevated 2.1 G by 
an early suit, which covered the body well above heart level, and 1.8 G by the 
Mark III FFS, which came to the level of the lower ribs. 

Extensive flight tests were performed with the FFS. In one series in which 
66 pilots participated, G protection was stated to be 1.5 G, ascertained by the use 
of visual accelerometers in the aircraft. Thirty-four pilots (64 percent) stated 
that use of the suit reduced fatigue; 19 (36 percent) stated that it did not. The 
conclusion of the Royal Canadian Air Force was summarized as follows: 

It was the almost unanimous opinion of the pilots as a result of these trials (a) that 
although the suit does provide the advantages claimed for it, they are outweighed by its 
disadvantages in the air and on the ground, and (b) that the FFS Mark III is therefore not 
practicable to use under Tactical Air Force conditions as represented on this airfield. 

Thus, while the FFS was entirely automatic and required no installation in 
the aircraft and although it performed the function for which it was designed, 
it failed to obtain general acceptance by pilots because of its weight, bulk, and 
restriction of movement. 

Following the investigations of Jongbloed and Noyons in Holland in 1933, 
the work of Commander J. R. Poppen was among the first done in the field of G 
protection in the United States. These studies were first carried out at Harvard 
University, at the School of Public Health, under the sponsorship of the Navy 
Department, and subsequently at the Naval Aircraft Factory in Philadelphia. 



286 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

Dogs were used in this early work for laboratory purposes. As a result of this 
investigation a compression belt was developed, the object of which was to pro- 
vide support to the abdominal area as a means of helping to overcome blood 
pooling in the splanchnic vessels. The appliance was extensively flight tested, 
but at this stage of development it was not considered successful. Armstrong 
and Heim, working at the AAF Materiel Center, Wright Field, in 1938, designed 
a belt which was inflated by a CO2 cylinder in a manner similar to that used for 
inflation of the May West life vest. 

Developed by Dr. Frank S. Cotton of Sydney, Australia, one of the first 
complete pneumodynamic suits was the Cotton aerodynamic anti-G suit 
(CAAG), which consisted of a series of rubber units applied to the body so as to 
cover it from the feet to the level of the lower ribs. Each unit consisted of a 
rubber "bag" overlapping its neighbor above and provided with an exit tube for 
inflation with air. For convenience these units could be fused together in 
various ways. Design had progressed to such a point in October 1941, that 
the following descriptive statement could be made: The device included (1) an 
apparatus for inflating the rubber units automatically, so as to provide in each 
the correct pressure for the height of the region above the soles, in the case of any 
particular G operating during a "loop," and (2) an inextensible outer suit to 
give support to the inflated rubber bags and to fit the body sufficiently well to 
avoid excessive ballooning. The inflation device consisted of a hydrostatic 
reservoir whose approximate height was equal to the distance between the soles 
and lower ribs of the seated pilot. All pilots who wore the pneumodynamic 
suit found that resistance to blacking-out increased and that the fatigue and lassi- 
tude commonly experienced after a number of high-G maneuvers was dimin- 
ished; they finished the trials quite fresh, while the unprotected pilots were 
markedly fatigued. With the suit, pilots were able to look about the check in- 
struments with ease during high-G, without the customary straining and bend- 
ing of the head to one side. The dragging effects of high-G on the cheeks and 
eyelids remained, as did the heaviness of the limbs, but the pilots could at all 
times control their aircraft without difficulty. 

Efforts to simplify the Cotton suit led to the Kelly one-piece suit (KOP). 
Models of this were made both with and without pressurization of the feet and 
with five and three different pressures. It was noted that use of three pressures 
was as effective as use of five pressures. This suit was still heavy and complex. 

In the fall of 1942, while a pneumatic anti-G suit made by Mr. David Clark 
was being given centrifuge tests at the Mayo Aero Medical Unit, preliminary 



RESEARCH AND DEVELOPMENT 



287 



tests were made at the suggestion of Dr. E. H. Wood on a suit altered so that it 
consisted of inflatable cuffs around the thighs and arms and an abdominal 
bladder. This suit was based on the idea that inflation of arm and leg cuffs to 
pressures high enough to occlude the principal arteries in these regions would 
cause cessation of blood flow to distal parts, thus limiting the volume of the 
peripheral vascular bed, increasing blood pressure in the remainder of the body 
and improving blood flow through the head during increased positive G. The 
idea was a departure from those in use up to that time since it removed emphasis 
from the concept of supporting return of venous blood from the lower parts of 
the body and placed it on the stopping of blood flow through less critical areas 
in order to augment flow through more critical ones. 

This prototype suit, which became known as the Clark- Wood suit, or the 
arterial occlusion suit (AOS), was further refined by Mr. Clark and Dr. Wood. 
The suit consisted of four pneumatic cuffs, one mounted around each extremity 
close to the trunk, and an abdominal bladder. Bladders were made of gum 
rubber on semicircular-shaped forms so that they tended to fit themselves to the 
underlying parts even when uninflated. Individual groups of bladders con- 
sisted of several such cells, lying parallel to one another, each encased in its 
compartment made of the supporting cloth of the suit. The result was a series 
of narrow air cells interconnected but separated by septa, a construction which 
minimized the tendency to assume a spheroid shape when inflated. The ab- 
dominal bladder group was made in right and left sections which were brought 
together by slide fasteners in the midline in front. Air entered at the left and 
reached the right side of the suit through tubes which passed across the back. 
Outward expansion of the bladders was limited by cuffs of inelastic cloth, sup- 
ported by metal stays, which were fastened taut around the bladder groups and 
secured by slide fasteners. 

The suit was inflated to three separate pressures: (i) the thigh cuffs to 
4 psi plus i psi per G, (2) the abdominal bladders to 1 psi plus 1 psi per G, and 
(3) the arm cuffs at a constant pressure of 4 to 4.5 psi. Thus, pressures at 6 G 
were: thighs, 10 psi; abdominal section, 7 psi; and arms, 4 psi. The AOS 
afforded a high degree of protection against effects of increased positive G. 
Data from the Mayo Aero Medical Unit indicated an average visual protection 
of 2.6 G. A later model was made without cuffs. 

The AOS with the GPS (below) was tested at the AAF Proving Ground 
Command, Eglin Field, in September and October 1943. The G protection 
offered was found to be adequate, but the suit was rejected because (1) pilots 
found inflation to the high pressures uncomfortable, and (2) pilots complained 
that inflation of the arm and thigh cuffs to the arterio-occlusive pressures pro- 



288 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



duced tingling and numbness of the extremities in maneuvers of moderate dura- 
tion and pain during prolonged exposures to positive G. As a result of these 
trials the AOS was abandoned as a practical suit for military use. It was a 
useful tool in the study of effects of pressurizing various parts of the body on G 
protection. 

The gradient pressure suit (GPS) was developed by the U. S. Navy together 
with the Berger Brothers Company. This suit consisted of a pair of fitted 
overalls ensheathing rubber air bladders. Groups of bladders were contained 
in casings of relatively inelastic lieno-weave cloth. Rubber tubing conveyed 
air under pressure to the bladders. Four transversely placed bladders overlaid 
the posterior surface of each calf and four bladders overlaid the anterior surface 
of each thigh. Each of the upper three members of these groups of bladders 
overlapped the bladder below it. The abdominal bladder, a crown-shaped 
rubber sac containing internal septa to prevent assumption of a spherical shape 
during inflation, was incorporated into a corset-like belt stiffened with seven 
steel stays. Compartments containing the bladders could be opened by slide 
fasteners to facilitate repair and replacement. Once hung over the shoulders by 
suspenders, the suit was fastened in place by means of slide fasteners, one of 
which brought together the two sides of the abdominal belt, and two of which 
ran the length of the garment, closing it around the legs and thighs. The suit 
was made in four sizes: large long, large short, small long and small short. 
Further adjustment was provided by laces placed anteriorly over the legs, 
posteriorly over the thighs, and laterally at the flanks. Straps within the suit 
could be adjusted to vary leg length and determine the position of the abdom- 
inal belt. The weight of this suit was approximately 10 pounds. 

Air pressure was supplied by the positive pressure side of the vacuum instru- 
ment pump and was metered to the suit by the G-i valve, to be described 
later. Three pressures— high, intermediate and low — were supplied. The high 
pressure was delivered to the two bladders over the ankle area, the intermediate 
pressure to the upper two calf bladders and the abdominal bladders, and the 
low pressure to the four thigh bladders in each leg. Hence the term "gradient 
pressure suit" was not strictly applicable, since abdominal bladder pressures were 
higher than thigh bladder pressures. Three tubes emerged from the left side 
of the suit at waist level and terminated in a male disconnect fitting, which 
mated with a female counterpart on the G-i valve. 

Average visual protection afforded by the GPS in centrifuge tests at the 
Mayo and ATSC centrifuges were found to be 1.3 and 1.5 G, respectively. The 
results obtained in the two laboratories agreed closely except for the greater 
protection against blackout recorded in the tests by ATSC. The fact that the 



RESEARCH AND DEVELOPMENT 



289 



test run employed at the ATSC centrifuge was of 10 seconds' duration whereas 
that at the Mayo Aero Medical Unit was of 15 seconds' duration was 
advanced as an explanation of the discrepancy, on the basis that the suit might 
have delayed onset of visual symptoms to an extent that 10 seconds were insuffi- 
cient for blackout to develop a lower G level when the suit was worn. If this 
were the cause, the same phenomenon should have been observed in later assays 
of the G-3 and G-4 suits, since the difference in duration of exposure remained 
the same. However, this did not occur. Apparently no satisfactory explanation 
to explain this difference was found. 

As noted, flight service trials of the GPS along with the AOS were carried 
out by the AAF at the Proving Ground Command, Eglin Field, Florida, 
in September and October 1943. Results of these tests confirmed centrifuge 
data which indicated that the suit protected the wearer against the effects of 
increased G. Whereas some degree of visual impairment occurred in all dive 
and pullout maneuvers, 180-degree turns, and 360-degree spiral turns in which 
acceleration reached 7 to 9 G when no suit was worn, visual dimming occurred 
in only one of 15 dive and pullouts, one of three 180-degree turns, and three of 
five 360-degree turns at this G level when the GPS was worn. It was concluded 
by the Proving Ground Command and the AAF Board that the GPS provided 
adequate G protection, was operationally reliable and should be given combat 
trials. Minor changes in the suit were made as a result of these tests. All 
rubber tubes were made kinkless by spring inserts, a hard rubber air distribution 
box located in the region of the shoulder blades was removed, the knee dimen- 
sions were enlarged, a test kit for the valve was devised, and the valve was made 
to begin suit pressurization at 2.5 instead of 1.5 G. 

Twenty-two GPS, units were taken to the Eighth and Ninth Air Forces in 
the ETO in December 1943, by Capt. G. L. Maison. When the results of non- 
operational tests were complete, the Eighth Air Force ordered 1,000 units for 
combat use. Five hundred were delivered before the G-i assembly was replaced 
by the simpler G-2 suit and valve. 

Thus, centrifuge and field trials of the G-i suit established the fact that 
anti-G suits which offered a protection of 1 to 1.5 G on the centrifuge would be 
adequate in contemporary aircraft, which initiated the trend toward lower suit 
pressures than those employed in the AOS, and served to introduce G suits into 
Army Navy combat units. Yet the suit had many defects. It was heavy (10 
pounds), hot, restricted movement too much, and, with its complicated valve 
and oil separator, imposed more weight penalty on the aircraft than was 
desirable. It was obvious to both services that simplification was necessary. 



290 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

Centrifuge studies with the G-i suit produced evidence that the three 
pressure system was an unnecessary encumbrance. Lamport et al working at 
the Mayo centrifuge noted that the protection offered by a Type G-i suit 
remained the same whether it was (i) inflated with the standard gradient 
pressure arrangement, (2) used with a constant pressure in the abdominal 
bladder and gradient pressures in the leg bladders, or (3) used with a single 
pressure, increasing with the G, in the leg bladders and a constant pressure in 
the abdominal bladder. The Wright Field group noted that the pressures 
actually delivered by the three pressure G-i valves were essentially the same and 
considered trial of a single pressure system the next step in simplification of 
the G-i suit. The Berger Brothers Company was requested to make such a 
suit, and the result became the AAF Type G-2. The G-2 suit was similar to 
the G-i suit in its general outward appearance, sizing, lacing adjustment and 
method of donning. The bladder system in the legs differed from that in the 
G-i suit in that there were long rectangular bladders lying lengthwise, one 
over each thigh and one over each calf. The abdominal bladder was the same 
as that of the G-i suit, but the abdominal belt was simplified by making it a 
part of the outer garment rather than a separate unit. All bladders were inflated 
to the same pressure. Thus the number of bladders was reduced from 17 to 5 
and much rubber tubing was eliminated. These changes simplified the suit 
and valve, and reduced the weight of the suit to 4V2 pounds. 

The protection offered by the G-2 suit on the centrifuge was determined 
on the Mayo and ATSC centrifuges. At the Mayo centrifuge with suit pressures 
of 1.25 psi per G average visual protection was 1.4 G. At the ATSC centrifuge 
with suit pressures of 1 psi per G, average visual protection was also 1.4 G. 
These values compared closely with centrifuge protection obtained with use 
of the G-i suit, validating the concept that a single pressure suit with no atten- 
tion given to inflation from below upward and no attention to the idea of 
gradient pressure can provide G protection of 1 to 2 G. 

The G-2 suit was given service trials at Eglin Field in February 1944, and 
approved to replace the G-i suit by the AAF Proving Ground Command and 
subsequently by the AAF Board. Protection in the aircraft, from observations 
in which the duration of acceleration was not taken into consideration, was 
similar to that noted with the G-i. Thirty-five hundred G-2 suits were sent 
to the Eighth and Ninth Air Forces and saw use over Europe. The G-2 suit, 
though an improvement over type G-i, remained more bulky and heavy than 
was desirable. Further attention to simplicity, coolness and lighter weight was 
clearly necessary. 



RESEARCH AND DEVELOPMENT 



291 



In January 1944 David Clark of the David Clark Company, Worcester, 
Massachusetts, and Dr. E. H. Wood of the Mayo Aero Medical Unit, 
introduced the use of a single-piece bladder system made of vinylite-coated nylon 
cloth to replace the older system of five separate bladders of rubber or synthetic 
rubber joined by rubber tubing. With this single-piece system the five air cells 
to cover abdomen, thighs and calves were formed by stitching the nylon cloth 
which had been cut to the proper pattern and sealing the seams with vinyl ite 
cement. Kinking of the connecting channels between bladders at the flexures 
of the body and of the tube which lead from the suit was prevented by a coiled 
steel spring insert placed within the bladder system. The vinylite-coated nylon 
cloth which gave support to the seams of the bladder during inflation. Develop- 
ment of the single-piece bladder system with spring inserts proved to be an 
important advance in the construction of G-suits and was subsequently adopted 
for all G-suits in use by the Army Air Forces and the U. S. Navy, whether the 
bladders were made of coated cloth or rubber substitutes. 

Twelve initial models of the single-piece nylon bladder system, single pres- 
sure suit, were made. All provided full coverage from the level of the lower ribs 
to the ankles, and all had essentially the same sized bladders. They differed 
in the manner of sizing adjustment, the method of keeping air lines open, and 
the method of opening the abdominal section. Average visual protection as 
measured in centrifuge tests at the Mayo Aero Medical Unit was 1.9 G. This 
type of Clark nylon bladder suit was the lineal antecedent of the coverall type of 
suit used later by the U. S. Navy. For military use the abdominal bladder 
was made smaller to promote comfort during inflation, and the resultant de- 
crease in protection was accepted. In the spring of 1944 the most pressing need 
in G-suit development continued to be one for simplification, lighter weight, and 
coolness. The Mayo group had pointed out that the simple single-unit pneu- 
matic bladder system first made by Clark, if incorporated into any supporting 
garment which would provide reasonable fit and was relatively inelastic, could 
be expected to provide adequate G protection. The trend toward greater simpli- 
fication received much needed impetus when Lt. Comdr. Harry Schroeder, on 
returning from a trip to the Pacific Theater of Operations, recommended de- 
velopment of two garments for trial: One a skeleton suit consisting only of the 
supporting elements required by the bladder system, and the other a coverall 
patterned after the standard summer flying suit. The first was to be designed 
for use with other clothing, and the second to be used alone as a flying suit. 
This plan ultimately led to two types of suits which were called by the Army 
Types G-3 and G-4 respectively. The type G-3 suit was a wrap-around gar- 
ment, waist to ankle in length, which pressurized the same areas of the body 



292 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



as the G-2 suit but covered only those regions of the body which were actually 
pressurized: abdomen, thighs, and calves. The crotch and the anterior and 
posterior knee regions were cut away. Forty-one hundred Type G-3 suits were 
delivered to the Eighth, Ninth and Twelfth Air Forces during 1944. 

In November 1944, the G-suit was officially standardized in the AAF 
by authority of Assistant Chief of Air Staff, Materiel and Services (Tele- 
type AFDBS-4-A6481 dated 23 November), and issued on the basis of one 
suit for each fighter pilot in the AAF. The choice of suit to be pro- 
cured in quantity lay between the G-3 skeleton type and the G-4 coverall 
type to be described in a later section. All previous experience in the Eighth and 
Ninth Air Forces had shown that Army pilots preferred to fly combat missions 
in standard uniforms so that in event of being forced down in enemy territory 
they would both be easily recognizable as an officer of the US AAF, and wear- 
ing clothing which would be adequate and comfortable during long periods of 
imprisonment. Even the G-i and G-2 suits, when used in combat, were usually 
worn as an adjunct over standard clothing. Largely because of this fact, the 
skeleton suit, which was designed for use with other clothing, was selected for 
routine AAF use. 

The suit finally evolved for production purposes differed in details from 
earlier G-3 suits and was designated AAF Type G-3A. Essentially the G-3A 
suit was a modification of the Clark G-3 suit, in that it utilized the single piece 
bladder system with spring insert, had no tubing across the back, and carried 
the slide fastener which closed the abdominal belt section on the right side. 
The following details of construction of the G-3A suit may be noted : 

1. Previous experience with fabrics for use in G-suits had indicated that 
the cloth should withstand tearing forces of 125 pounds on the warp and fill. 
Use of airplane cloth in a few instances had resulted in some tearing of the 
outer cloth in ordinary usage. Oxford-weave nylon cloth and basket- weave 
nylon cloth conforming to AAF specifications were satisfactory. In the G-3A 
suit, the basket weave nylon cloth was used to form the outer garment, whereas 
the oxford-weave cloth, chosen because it had less tendency for slippage at the 
seams, was used for the envelope immediately surrounding the bladder system. 

2. Slide fasteners for the legs and abdominal section were of the Talon 
Type iA. This fastener, slightly larger and heavier than the Talon type pre- 
viously used in G-3 suits, was chosen because it was easier to engage and being 
stronger could be expected to result in few maintenance problems. 

3. Like the G-i, G-2 and G-3 suits, the G-3A suit was made in four sizes: 
large long, large short, small long, small short. Laces over the calves, thighs 
and flanks provided further adjustment of size. 



RESEARCH AND DEVELOPMENT 



293 



4. The single-piece bladder system was made of neoprene and encased in a 
close-fitting bladder envelope of oxford-weave nylon. Tabs from the bladders 
protruded through slits in the bladder envelope. The bladder in its en- 
velope was placed inside the outer casing to fasten the bladder system in place. 
Thus the bladder system of the G-3A suit could be removed for repair or replace- 
ment. The complete G-3A suit weighed 3V4 pounds. This figure was to be 
compared with 2% pounds for the Berger G-3 suit and 2% pounds for the 
Clark G-3 suit. The G-3A suit had been manufactured by the Berger Brothers 
Company and by Munsingwear, Inc. 

Centrifuge tests at the Aero Medical Unit, where the G-3 suit was 
pressurized at 1.0 psi per G on a scale which assumed pressure rise to begin at 
o G, indicated that the average visual protection was 1.1 G. The corresponding 
figure from the Mayo Aero Medical Unit was 1.2 G. Observations made 
in the Twelfth Air Force in the MTO established the fact that the G-3 suit gave 
adequate protection in the aircraft. 

The G-i suit demanded that air be delivered at three pressures, each increas- 
ing with G. The G-i valve designed by the Berger Brothers Company to meet 
these requirements consisted of a G-activated, spring-loaded, poppet-type control 
valve which functioned to divert all inlet air to the exhaust manifold until 1.5 G 
was reached and to direct inlet air to the three pressure-regulating valves at 
accelerations greater than 1.5 G. The three pressure regulating valves were 
identical in principle to the pressure regulating part of the M-2 valve which will 
be described below. Output air from each of the three pressure regulating 
valves was led to the quick detachable fitting cup, a female unit which mated 
with the male fitting attached to the G-i suit. A seeker in the disconnect fitting 
insured that the suit was properly attached to the pressure leads from the valve. 
The disconnect fitting on the valve could be removed and placed remote from 
the valve where lack of space in the cockpit made it necessary. The valve was 
11 inches long and weighed 6V4 pounds. Air for the valve was furnished by 
the vacuum instrument pump. In the G-i assembly, air from the B-12 oil 
separator in the plane was led to a highly efficient oil separator, provided by the 
Berger Brothers Company, which removed residual oil. This added separator 
was used to protect the gum rubber bladders of the G-i suit from oil vapor. 
From the second oil separator, air entered the G-i valve. 

The discovery that single pressure suits were equally effective as suits with 
multiple pressures rendered the G-i valve with its accouterments obsolete. 

In January 1944, when the AAF changed from the triple pressure G-i suit 
to the single pressure G-2 suit, a valve was needed which would pressurize the G- 
suit at a single pressure of 1 psi per G and adequately pressurize the auxiliary 



294 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

fuel tanks as well. Military requirements demanded that a valve combining 
these functions be developed quickly. The M-2 valve was designed by the 
Berger Brothers Company, New Haven, Connecticut, to serve these purposes. 
When this valve was standardized, it became the AAF type M-2 valve. 

The M-2 valve consisted of two connected valve units: the control valve and 
the pressure-regulating valve. The control valve's function was to direct air to 
the tank port in level flight and to the pressure-regulating valve during maneu- 
vers which produced positive G. It was a three-way, spring-loaded, G-activated, 
weighted poppet-type valve. At accelerations smaller than that required to 
trip the valve, the control valve stem and weight were held in the up position by 
the control valve spring. The control valve poppet head was seated above, and 
air entering the inlet port passed out the tank port to be led overboard or to pres- 
surize the auxiliary fuel tank system. At accelerations great enough to trip the 
valve, the combined weight of the control valve stem and superimposed weight 
was sufficient to overcome the control valve spring and cause the valve system 
to move downward, unseating the poppet above and seating it below. Air was 
then directed through the upper poppet seat to the pressure regulating valve. 
If the tank port was vented to ambient air, the control valve tripped at 2.75 G. 
If auxiliary tanks were being pressurized to 4 to 5 psi, this pressure, acting 
upward against the area of the upper poppet seat, lent support to the control 
valve spring and raised the acceleration required to trip the control valve to 
approximately 4 G. 

The function of the pressure-regulating valve was to meter air to the G-suit 
at a rate of approximately 1 psi per G. This was accomplished by variation in 
the size of the valve vent orifice. The size of this vent orifice was determined 
by the position of the pressure-regulating valve stem. The position of this stem, 
in turn, was determined by the forces acting upward and downward upon it. 
During increased positive G, the effective weight of the valve spring and super- 
imposed weight, increased with the G and aided slightly by the low-rate pressure- 
regulating valve spring, acted to depress the stem and close the vent. At the 
same time, air pressure within the sylphon, acting upwards against the lower 
surface of the pressure-regulating valve weight, acted to raise the stem and open 
the vent. The balance between these forces determined stem position and 
orifice size at a given moment. The pressure required to vent the valve, there- 
fore, increased with the G. The vent orifice served to empty the suit when the 
episode of increased G had passed and the control valve had closed. 

The Type M-2 valve for pressurization of the pilot's anti-G suit was author- 
ized by Technical Instructions dated 13 November and 2 December 1944, to be 
installed in every fighter type aircraft with the exception of the P-59, P-61, 



RESEARCH AND DEVELOPMENT 



295 



P-63 and P-39. However, with the arrival of the P-80 it was apparent that the 
M-2 valve, receiving air from the the compressor discharge of the J-40 turbo-jet 
engine, failed to meter the proper pressure to the suit during G and did not 
conserve air in level flight. 

To remedy this, a new type of valve having the proper characteristics for 
use with jet aircraft, i. e., the ability to deliver the correct pressure to the suit 
when the input pressures ranged from 10 to 125 psi, and having the ability to 
conserve air when the aircraft was in level flight, was developed. It turned out 
to be small and compact, weighing approximately 3% pounds. A manual 
control unit provided inflation of the suit during level flight. This feature was 
added to the valve for the benefit of those pilots who felt that a massage-like 
effect during long range flying decreased fatigue. It was designed to be mounted 
to the left of the pilot's seat within easy reach of the pilot to allow him to select 
pressure or manually inflate the suit in level flight with ease. 

Medical Logistics 

As the geographical extent of allied participation in the war progressed, 
it became apparent that, for maximum mobility, air transport of critical supplies 
was essential. This also proved true for the evacuation of casualties. In imple- 
menting these ideas, the Aero Medical Laboratory devoted a part of its efforts 
in developing facilities for the air transport of wounded and for medical sup- 
plies and equipment. In carrying out this program, the pattern of procedure, 
i. e., research and development, testing, standardization and procurement, 
followed that already established by the Command. Although a number of the 
devices required relatively little attention and will be merely mentioned or 
briefly described here, several were of sufficient moment to constitute major 
research programs. 

In the latter category falls the problem of air evacuation equipment, and 
principally webbing strap litter supports for installation in cargo aircraft. The 
need for this equipment was anticipated even before U. S. entry into the war, and 
the program was vigorously pursued throughout its course. The following dis- 
cussion of this development is taken, with minor changes, from a report 19 by 
Col. W. R. Lovelace, dated 20 September 1945. 

Even before the onset of World War II, it was realized that evacuation of 
sick and wounded by air was desirable, inasmuch as it possessed numerous 
advantages over conventional methods of transportation. There was, first, 
the great speed with which evacuation from forward zones could be accom- 
plished as contrasted with the rough, tedious ride in motor ambulance, 



296 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

for greater comfort and safety. Although requiring fewer medical personnel, 
as well as less field equipment, air evacuation nevertheless permitted constant 
medical observation and care during flight. Air evacuation meant less conges- 
tion on the land lines of communication and, indeed, permitted transportation 
of medical supplies, including whole blood, to the point of pickup. Finally, 
by reducing the time required to bring the badly injured and seriously ill to 
points where definitive medical and surgical treatment was available, the chances 
of recovery for those patients were greatly improved with, consequently, a 
considerable increase in morale. 

Coupled with these benefits of air evacuation were a number of disadvan- 
tages. Aircraft required landing fields and servicing facilities. Aircraft could 
not be used when weather was unfavorable and were subject to attack by enemy 
aircraft, a condition, however, which constituted no problem in World War II. 
And, of course, airplanes needed trained pilots, although it must be emphasized 
that such pilots would be carrying cargo and personnel forward and returning 
with empty aircraft. 

At the beginning of the war, an aluminum, bracket-type litter was installed 
in the C-47, an aircraft with a capacity of 18 patients and accommodating 
only steel and aluminum pole litters. This was later modified to accom- 
modate American wood pole and British and Australian litters. After the 
bracket-type litter installation was used successfully in the evacuation of several 
thousand patients, a number of disadvantages became apparent which neces- 
sitated establishing new requirements for litter installations. Since only a 
small number of the several hundred metal fittings used to support the litters 
were permanently installed, many of them, each one of which was critical for 
safe transportation, were lost during flight. These fittings were constructed 
of aluminum, then a critical material, and, in addition, many were not inter- 
changeable. Each installation weighed 218 pounds (average weight per litter, 
12 pounds), with bulky component parts, and only 18 litter patients could be 
transported in spite of the fact that, from the weight standpoint, the aircraft 
could take off easily with 24 patients. Setting up the equipment was difficult, 
requiring trained personnel, and such litters as the Stokes or the Australian 
could not be accommodated. Large storage facilities were necessary and in- 
stallation of equipment and loading of patients took considerably more than 
10 minutes. Any attempts at standardization of the equipment for different 
types and sizes of aircraft would have been extremely difficult. 

In June 1942 Colonel Lovelace drew up a suggested list of requirements 
for litter installation in cargo aircraft. All items of the litter-retaining equip- 
ment were to be permanently installed, not only to avoid loss or damage, but, 



RESEARCH AND DEVELOPMENT 



297 



what was more important, to insure that any cargo aircraft at any temporary 
or permanent airport could be converted in a very few minutes to carry litter 
patients. Using non-critical items wherever possible, a minimum number of 
parts were to be employed, thus helping to conserve critical aluminum and to 
relieve the supply problem. In order not to decrease the payload of the aircraft 
appreciably in terms of cargo or passengers, which would constitute the air- 
craft's load for the greatest part of its operational life, a minimum weight and 
bulk would be sought. Simplicity of operation and ease of maintenance would 
be the keynote, so that untrained personnel, having read the instruction attached 
to the cabin, could handle patients safely. 

Colonel Lovelace stipulated, in addition, a maximum capacity for both 
litter and ambulatory patients, but sufficient flexibility so that patients with large 
casts could be transported by the omission of the litter above such patients, and 
enough aisle space and room between the litters to permit care of patients while 
in flight. He sought speed and ease of unloading (neither to require more than 
10 minutes) to facilitate evacuation from hazardous forward areas, and 
stowage facilities that would not interfere with the function of the aircraft 
when used for transporting cargo or passengers. Lovelace's design specifica- 
tions would accommodate American wood, aluminum and steel pole litters; 
the Stokes litter; British Mark II wood pole; Australian and French letters; and 
if possible, litters used by the enemy. American, British, and Australian litters 
varied in length from 88 to 92 inches, in width from 21% to 24 inches, the 
diameter of the poles from 1 to % inch, and the stirrups both in height and 
location on the pole. These were all difficulties which had to be overcome in 
the design of the litter support installations. 

The Evans litter, designed by a Fairchild engineer of that name, proved 
to be the answer. In September 1942 Colonel Lovelace participated in a 
mock-up inspection of the XC-82 at the Fairchild Engine and Airplane Corpo- 
ration, demonstrating a mock-up of a litter installation for 33 patients, which 
consisted essentially of solid fittings on the sides of the fuselage to hold the 
litter poles, and webbing straps with loops sewed into them to hold the poles 
on the other side of the litter. On his return to Wright Field, a recommenda- 
tion was made that the question of developing and standardizing a simplified 
webbing strap type litter installation in all cargo airplanes be investigated. 
This recommendation was coordinated with Col. E. L. Bergquist, Surgeon 
for the Troop Carrier Command at that time. 

As the result of a conference with the Aircraft Laboratory, it was agreed 
that a standard webbing strap litter support installation should be developed 
which would be suitable for use in all cargo aircraft. A drawing was prepared 



298 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



by the Aircraft Laboratory in conjunction with the Aero Medical Laboratory 
which illustrated different arrangements for litter installations in cargo aircraft 
and established the dimensional requirements as to the distance necessary be- 
tween the litter supports, the vertical interspace between litters, the maximum 
height for the highest litter, and the aisle space necessary between the tiers of 
litters. The installation was to be made so that 20 percent of the litters could 
be tilted. Following this, standard AAF drawings were prepared for a complete 
webbing strap litter installation, including the wall brackets and the inboard 
litter support straps with the necessary loops for the litter poles and the strap 
clamps to hold them in position, the intercostals, the floor attachments for the 
outboard poles of the lower litters, the tie-down strap for the inboard pole for 
the litters placed on the floor, and canvas bags for litter strap stowage. In a litter 
installation in C-46 aircraft, the wall brackets were made so that they could be 
folded out of the way. Another litter development was the design of a fitting 
by means of which a Stokes litter could be accommodated. 

The component parts of the complete installation were manufactured by a 
local concern and an installation was then made in a C-47 fuselage. It was 
observed that the bucket seats could be folded out of the way. If desired, some 
of the bucket seats could be left up for use by ambulatory patients. When the 
Evans canvas-type seat was used, it could be rolled up readily and fastened to 
the wall when litter patients were carried. Seats were available for use by the 
medical personnel on the larger aircraft. 

Complete static tests were carried out on the above installation. One thou- 
sand pounds of lead shot were loaded on each litter, and there was no failure of 
the equipment or any part of the aircraft structure, either with this load or with 
the fore and aft load of 1.5 G. 

At the completion of static tests, the entire installation was thoroughly 
inspected by Col. R. T. Stevenson, Surgeon for the 349th Air Evacuation 
Group, Bowman Field, and members of his staff, at which time, after loading 
and unloading litters in the O-47, several suggestions for improvement were 
made which were incorporated later in the final design of the webbing strap 
litter support. The support soon became standard for all AAF cargo aircraft, 
and production installation was first made in the C-47. 

After extensive service tests of the webbing strap litter installation in the 
C-47, carefully supervised by Maj. D. M. Clark of the Aero Medical Laboratory, 
provisions were made for installing this type of equipment in the C-46. The 
shape of the fuselage and arrangement of the seats in this aircraft necessitated 
the use of litter support poles for securing the wall brackets to provide inboard 



RESEARCH AND DEVELOPMENT 



299 



support of the litters. Subsequent to this, webbing strap litter supports were 
installed on the production line in all new cargo aircraft. 

The installation in the O82, which consisted of six tiers of five litters each 
and one four-litter tier on the right side forward, giving the plane a litter 
capacity of 34, was accepted at an inspection of the C-82 airplane on 2 and 3 
October 1944. Because of the rectangular shape of this aircraft, it was partic- 
ularly suitable for installation of litter equipment and the transportation of 
patients. When not in use, the outboard straps could be unhooked from the 
floor and rolled up into stowage bags located on the ceiling near the upper 
support. 

An evaluation of the webbing strap litter installation, in terms of the 
requirements established for litter installations in cargo aircraft, revealed several 
interesting points. In the first place, all the retaining equipment, except for 
small straps holding the inboard poles of the litters located on the floor, were 
permanently installed, thus minimizing loss or damage. There was a minimum 
of small parts, with construction mostly of parachute webbing, the latter effect- 
ing great savings in aluminum (1,000,000 pounds saved, in contrast with the old 
aluminum bracket-type installation, according to an estimate in 1944 by the 
Air Materiel Command). The litter-retaining equipment weighed an average 
of 3 pounds per litter contrasted with 12 on the older type, and the entire installa- 
tion, easily maintained by untrained personnel using written instructions, insured 
a maximum capacity of litter patients for all types of cargo aircraft. Thus, in 
the C-47, 24 patients could be carried in comparison to 18 with the old installa- 
tion, a condition that was of very great importance during the first 2 months 
loading patients. The largest aircraft, and the first with a pressurized cabin, 
in which this type of litter installation was made, was the C-97, which accom- 
modated 92 litter patients. 

The new litter installation accommodated American, British, Australian, 
French, German, as well as the Stokes, litters. Inasmuch as, in combat areas, 
patients were brought to the airport on many different types of litters, it was 
imperative that they not be changed from one type to another, because of danger 
to the patient, loss of time, and shortage of litters. Except in the C-47, where 
the rear tier of litters by the door could accommodate only the American litters, 
a combination of any of the above-named litters could be used in one aircraft. 
The standard litter installation was placed in all cargo aircraft, the only major 
difference in installation in different types of aircraft being the length of the 
outboard litter support straps. This standardization resulted not only in simpli- 
fying the supply of litter installations to aircraft companies, but also speeded up 
production line manufacture of the installation. 

262297 °— 55 21 



300 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Additional characteristics of this type of installation were the litter strap 
bags located on the ceiling which accommodated the litter support straps and 
were always out of the way of cargo and personnel ; the ease of preparation of 
the C-4.7 for loading patients (a well-trained crew took only 8 to 10 minutes 
to prepare the plane and load 24 patients) ; ease of maintenance in the field; and 
sufficient aisle space between litters to care for all patients except those with 
casts, in which case it might be necessary to omit the litter above the patient. 
When the outside air temperature was low, it became necessary to place a blanket 
under the litters situated on the floor to prevent radiation of cold to the patients, 
and at times cold radiation from the walls required an extra blanket between 
the patient and the wall. 

Another interesting development sponsored by the Aero Medical and 
Equipment Laboratories during 1944 was the airborne hospital shelter unit. 

Two types of shelters were developed: one for use in the tropics and one 
for installation in cold climates. Provision of adequate ventilation was stressed 
in the design of the former, and, in the latter, insulation against cold was in- 
corporated into the construction. The structural characteristics of the two types 
were similar. Both had a main room 16 by 16 feet and a vestibule of 8 feet 
square. All windows were screened on the inside; the sashes opened outward 
and were controlled by bars extending into the interior. Provision was made for 
the use of electricity by the installation of an electric inlet. A stovepipe outlet 
was cut in the gable. A tropical unit with the above dimensions weighed ap- 
proximately 3400 pounds, and an arctic unit of similar size weighed 3,700 
pounds. Either unit could be easily stowed in about two-thirds of the cargo 
space of C-47 airplane and could be erected by a four-man team in 2 hours. 

The units were designed to be set up in combinations to meet the require- 
ments of the local situation. When the units were so combined, the extra vesti- 
bules could be used as storage and utility rooms. The vestibule was large 
enough so that when a patient was brought in, the outer door could be closed 
before the inner door was opened. In cold climates this feature conserved heat, 
and in the tropics it kept out insects and other pests. 

It was estimated that this shelter would be valuable in many situations. 
Probably one of its greatest uses would be on forward airfields. There it could 
be erected beside the apron of the airfield, where it could serve as a collecting 
station* Treatment could be carried out while patients were being collected 
at the shelter and awaiting further evacuation. A cargo plane could taxi up to 
the shelter, and the patients, still on the original litters, could be loaded directly 
from the shelter to the plane. The unit could also be used as an operating 
room or dispensary. 



RESEARCH AND DEVELOPMENT 



301 



Each could accommodate 12 patients on litters and was equipped with 
webbing strap litter supports, which were the same as those later installed in 
cargo planes. This installation consisted of litter wall brackets and web strap 
belt assemblies. An outstanding advantage of this arrangement was that it 
obviated the transfer of patients to and from litters. The casualties remained 
comfortable and undisturbed on the litters on which they were brought in. 

Numerous other small but nonetheless important items of airborne medical 
equipment were also developed. These can be merely listed as follows: 

1. Therapeutic oxygen kit for use in air evacuation and in ground ambu- 
lances. 

2. Combat-type compression dressings. 

3. Knife, emergency, curved, for the removal of clothing from injured 
flyers. 

4. Restraint for mental patients. 

5. Case, airplane ambulance, for medical equipment used in air evacuation. 

6. Packet, first aid, individual aviator's for use by tactical personnel. 

7. Airborne cot-litter. 

8. Deodorizing equipment for use in air evacuation. 

9. Trailer ambulance for use in air evacuation. 

10. Venturi aspirating equipment. 

Two other items of equipment developed by the Aero Medical Laboratory, 
because of their widespread usefulness, deserve especial mention here. The 
first was the aerosol bomb for the dispersal of insecticides. Heavy air traffic in 
the AAF linked areas in which yellow fever and malaria were endemic with 
regions not involved but which harbor the vectors of these diseases. The need 
for eliminating mosquitoes was emphasized early in the war. In 1942 Lt, 
William N. Sullivan, SnC, working at the Aero Medical Laboratory, developed 
a portable bomb for dispersing a Freon-pyrethrum-sesame oil insecticide in 
aerosol form for the disinsectization of aircraft. Modified for commercial pro- 
duction, the bomb was subsequently adapted for use in trenches, foxholes, bomb 
shelters, barracks, and houses. On open ground, the contents of a single bomb 
would eradicate mosquitoes in an area of more than one acre. 

The mechanics of the bomb were simple. The original bomb prepared by 
Sullivan for commercial production consisted of a cylinder with a capillary tube 
secured to the inner wall with small clips and sealed. A release pin at the top 
of the cylinder broke the seal, releasing the aerosol propelled by the Freon ingre- 
dient. Flow was stopped by means of a small cap taped to the side of the cylin- 
der. A later production model incorporated a valve in the top through which 



302 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

the aerosol was released. The final model featured a valve by which the cylin- 
der could be recharged repeatedly. 

The bomb contained 4 percent pyrethrins and 8 percent sesame oil in Freon, 
after a formula first reported by Goodhue and Sullivan, then with the Bureau of 
Entomology and Plant Quarantine. The combination was found to be highly 
effective against mosquitoes and related insects but less effective against flies at 
dosage recommended for mosquitoes. 

Investigations by the Bureau of Entomology and Plant Quarantine in coop- 
eration with the Army and Navy showed that the addition of DDT to the 
pyrethrum aerosol formula greatly improved its effectiveness for general use 
and reduced the required pyrethrum, of which there was a critical shortage. 
The new formula contained 3 percent pyrethrum, 3 percent DDT, 5 percent 
cychlohexanone and 5 percent lubricating oil in Freon 12. Lubricating oil 
was found to be as effective an activator as sesame oil. The cyclohexanone 
acted as an auxiliary solvent for DDT. The presence of DDT made the solu- 
tion lethal to flies, retained about the same efficiency against mosquitoes, and 
permitted a 25-percent reduction in pyrethrums. 

The other item was the pneumatic balance resuscitator developed by H. L. 
Burns, during the latter months of the war. Reports from combat theaters had 
indicated that flying personnel who had succumbed to anoxia frequently required 
artificial respiration. The difficulties encountered in administering manual 
resuscitation during combat and flight in military aircraft made it desirable that 
automatic manual means of resuscitation be devised. An automatic cycling 
valve, which converted a continuous positive pressure into an intermittent posi- 
tive pressure and thus acted as a resuscitator, was developed. Accessory equip- 
ment required for the use of the resuscitator consisted of a pressure mask, a 
source of positive gas pressure (compressed air or oxygen) and a reduction 
regulator. One of the chief advantages of the device, in addition to its desirable 
performance characteristics, was its extreme simplicity of construction (no 
springs or bearings involved), its small size and light weight. Extensive tests 
indicated that it was the most dependable and foolproof of all such devices in 
existence. 

It was found that resuscitators would follow the slightest breathing effort 
of the patient. No noticeable work was required to breathe faster and slightly 
deeper than the automatic cycling rate. Violent breathing was restricted on 
exhalation only, since an inlet check valve could be installed to allow air to 
enter the mask to take care of high inhalation rates. As the subject swallowed 
or attempted to breathe more slowly than the automatic cycling rate, the resusci- 
tator ventilated the mask at a high cycling rate without discomfort. 



RESEARCH AND DEVELOPMENT 



303 



Comments from personnel using the resuscitator indicated that it had a com- 
fortable and very close to normal breathing action but that for continuous use 
of over one hour some means of humidifying the supply of gases should be 
provided. Extensive clinical tests at the Bellevue Hospital in New York demon- 
strated its effectiveness on both conscious and unconscious individuals suffering 
from a variety of asphyxial conditions. 

Medical Instrumentation 

A record of the technical accomplishments of the Aero Medical Laboratory 
during World War II would not be complete without a discussion of the special 
medical instruments and physiological recording installations developed during 
that time. These new devices were almost exclusively a product of the Physics 
Unit under the guidance of Dr. Victor Guillemin. The activities of the Physics 
Unit were carried on continuously from December 1941 onward and thus ex- 
tended backward prior to actual activation of the Unit as a distinct organization. 

To a considerable extent, the Unit was a service organization for the 
entire Laboratory, providing advice and assistance in the investigations of 
physical quantities (light, heat, sound, electricity, mechanical forces, acceleration, 
and velocities) pertinent to aeromedical problems, collaborating with physiol- 
ogists and medical men in aeromedical research and development, and pro- 
viding the necessary special instruments and equipment. Thus, the activities 
of the Unit reflected the major research trends of the Laboratory as a whole. 

During 1942 the rush of work in the altitude and refrigerated-altitude 
chambers in connection with oxygen equipment and clothing development 
brought about an urgent need for an intercommunication system that could 
withstand the very severe conditions of temperature and ambient pressure 
changes and that could be used by subjects wearing oxygen masks. A satis- 
factory system was developed which later became the model for all AAF 
indoctrination chamber communication systems. During this same time two 
instruments were developed for clothing research, one a remote indicating 
electric thermometer, the other a watch-size recording thermometer-hygrometer. 

In 1942 plans were going forward for a large human centrifuge to be used 
for studies leading to the development of the anti-G suit. In numerous confer- 
ences with General Electric Company engineers, details of the control and 
recording equipment and of various safety devices were worked out. The 
adequacy of the latter is shown by the fact that, aside from a single purely 
structural failure during the initial test runs, the centrifuge subsequently oper- 
ated without a single accident. 



304 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

At this time the aero-embolism studies had advanced to the point where it 
seemed advantageous to use controlled amounts of exercise while breathing 
pure oxygen to speed up the denitrogenation of flying personnel before ascent 
to high altitudes. Since no suitable equipment was available, a new type of 
bicycle ergometer was developed with a direct reading work load meter. This 
was later used for giving measured work loads to subjects testing the performance 
of oxygen equipment in the altitude chamber. 

After the new centrifuge building was occupied in 1943, design and fabri- 
cation was undertaken of an auditory and visual signal and response system for 
automatically recording the reactions to high acceleration of a subject riding the 
human centrifuge, and of a system of mercury ring troughs and copper ring 
and brush assemblies for making electrical connections between the rotating 
centrifuge and the control and recording room. These instruments were used 
throughout the development of the anti-G suits and associated equipment. 

During the latter part of 1943 and throughout 1944, the major emphasis 
was on activities connected with the development of flying clothing, particularly 
electrically heated suits. Bombing missions of greater duration at higher alti- 
tudes made adequate protection against cold for flying personnel imperative. 
The only available electrically heated suit was the type-i, which was thoroughly 
unsatisfactory. The project of developing improved electrically heated flying 
suits was given to the Aero Medical Laboratory as the only organization in the 
AAF having adequate personnel and equipment. The Physics Unit collab- 
orated actively in this work. Fortunately, complete equipment for measuring 
body temperatures of subjects as well as environmental temperatures had already 
been installed in the Laboratory all-weather room and cold altitude chamber, 
and similar equipment had been developed for flight tests. In addition, this 
project required the development of a number of new instruments and new 
equipment, including a thermal insulation meter suitable for use on complete 
garments, a control panel for regulating the heat supply to various parts of 
experimental electrically heated suits, two greatly improved air speed meters, 
one for laboratory and the other for flight test use, a device for studying the 
action of thermostats for temperature control of electrically heated garments, 
a large wind machine, a precision wind tunnel for instrument calibration and 
a novel freezing-effect meter to evaluate the combined freezing effect of low 
air temperature and wind. The latter was used by personnel of the First Cen- 
tral Medical Establishment, England, in connection with the study of frostbite 
casualties in the Eighth Air Force. The series of laboratory and flight tests 
made with these instruments resulted in the F-3 electrically heated suit, which 
proved completely satisfactory. 



RESEARCH AND DEVELOPMENT 



305 



Early in 1944 studies were under way on explosive decompressions such as 
would occur in a pressurized aircraft cabin when ruptured by gunfire; these 
studies were intiated by the advent of the pressurized B-29, C-69, C-97, and 
later the P-80. A pneumatic decompression recorder was built for use in bomb- 
ers and transports, and a very rapid electric type was designed to be used 
on experimental mock-up of fighter cabins. 

As examples of assistance to other projects in the Aero Medical Laboratory 
may be mentioned: theoretical studies of optical properties of windshields and 
bubble canopies for the Vision Unit, assistance in the development of an oxygen 
moisture tester and design of a flight test oxygen tank temperature indicator 
for the Oxygen Branch, suggestion for adding nitrogen to the carbon dioxide 
in life raft inflation tanks to prevent malfunction at low temperatures, a pro- 
cedure which later became standard practice throughout the AAF, design of 
an electric pneumograph for the Respiration Unit, and design of a "thermal 
copper man" for the Thermal Research Unit. 

Clinical Aspects of Aviation Medicine 

Ophthalmology. It had long been realized that the task of flying was 
more dependent on vision than on any other of man's senses, the term vision 
denoting a number of different functions. Flying personnel needed good 
depth perception to land, take off, and accurately judge the altitude of aircraft 
during low-level strafing and bombing runs. They required good visual acuity 
to identify and hit targets, and they needed good night vision to see at night, 
especially under wartime blackout conditions. For these reasons, the Air Forces 
established elaborate examination procedures to insure the excellence of the 
vision of aircrew personnel. But all the advantages of careful selection were 
lost if the aircraft was not so designed as to enable the aircrew members to make 
effective use of this important sense. It was necessary that the field of view be 
as unhampered as possible in all directions, that the windscreens and canopies 
have good optical properties, and that the cockpit be provided with lighting 
which would not impair night vision. 

Investigations of these problems conducted by the Laboratory were in the 
main directed along three lines of approach: (1) studies of visibility and fields 
of vision from aircraft, (2) design and development of goggles and flying sun 
glasses, and (3) night vision studies. 

Maximum visibility was considered, of course, one of the prime require- 
ments in the design of military aircraft; but, in general, progress had been 
made in the development of transparent aircraft enclosures of high optical 



306 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

quality, particularly in those panels or sections through which bomb aiming and 
gun-sighting were done. Less attention had been devoted to the problem of in- 
creasing over-all visibility or fields of vision from aircraft enclosures. 

In view of this, a program was initiated to study means of improving air- 
craft visibility. Extensive measurements of the unimpeded visual field in 
fighter, bomber and cargo aircraft indicated that the number of accidents due 
to visual difficulties was higher in aircraft with restricted fields. This was 
particularly true in fighter aircraft and to a lesser extent in multiplace aircraft, 
where the presence of a co-pilot as an additional observer decreased the danger 
of the restrictions imposed upon the pilot. An additional impetus for analyz- 
ing the field of view from military aircraft originated in complaints and unsatis- 
factory reports from combat operational groups concerning visibility. First, 
there were many complaints of poor forward visibility in fighter aircraft while 
taxiing, with resulting accidents. Also, some pilots complained of the loss of 
visibility in landing after the nose of the plane was raised. Secondly, the reports 
often referred to poor visibility over the nose in fighter aircraft while in combat. 
For reasons of safety, fighter aircraft were often required to stay on the deck. 
It was seldom that they would see the target at this altitude because there was so 
little visibility over the nose. With the development of computing gunsights 
for fighter aircraft, the requirement for visibility over the nose increased. Gun- 
sights made possible deflection shots from 15 0 to 20 0 , but visibility over the nose 
was restricted to less than 8° or 9 0 . In the Me-410, 12 0 downward visibility 
over the nose was achieved in the taxiing position, while 20 0 was readily avail- 
able in the flight altitude. In the British Meteor, from 25 0 to 30 0 downward 
visibility over the nose appeared possible while in the flying altitude. On the 
other hand, none of the AAF fighters studied offered more than 9 0 downward 
visibility. Measurements of visual fields was accomplished with an instrument 
similar to an astrolabe. It consisted of a self-leveling vertical scale for reading 
angles of elevation and depression mounted on a directional gyro which pro- 
vides the azimuthal scale. Estimations were made at 5 0 intervals around the 
entire 360 0 azimuth. Visual field size was computed from these angles and was 
expressed quantitatively in steradians. The instrument was hand-supported 
and enabled the observer to move about in the cockpit within the limits of the 
shoulder harness and seat belt — thus providing estimation of a functional field 
of vision and simulating natural movements a pilot would make when pursuing 
an object or target visually. 

As a result of study conducted on various types of aircraft, it was apparent 
that fighter aircraft differed significantly in the size of the total field of vision 
and the amount of visibility over the nose. The P-63 had the largest total field 



RESEARCH AND DEVELOPMENT 



307 



of vision and the P-38 the smallest, a difference of 12 percent. The Me-410 gave 
the largest angle of downward visibility over the nose while the P--51B and P-47 
were poorest in this respect. The total fields of vision from the P-51B 
canopy and the P-51D bubble canopy were almost identical. It was empha- 
sized, however, that canopy structural members constituted handicaps for the 
pilot. The bubble type canopy was universally preferred over the older, ribbed 
and reinforced types, even though the total amount of visual field was not 
greater with the bubble canopy. 

On the basis of the data and experience accumulated, certain general recom- 
mendations regarding visibility and aircraft design could be made: 

1. Tricycle landing gear should be used to provide adequate forward visi- 
bility for taxiing. 

2. A minimum of 10 0 forward visibility over the nose in flight attitude 
should be provided; 15 0 for high speed aircraft. (This is measured from the 
horizontal viewing plane of the pilot.) 

3. Visibility in the aft portion of the field of vision should be at least 5 0 
below the horizontal viewing plane. 

4. Lateral portions of the field should provide no less than 50 0 downward 
visibility, except where this is impossible because of the structure of the wing. 

5. Structural parts of canopies should be eliminated as far as possible, com- 
mensurate with strength and safety. 

6. Cockpit lights, instruments, ventilation panel handles, etc., should not 
protrude above the fuselage into the transparent sections. 

Of equal importance with provisions for an adequate field of view were the 
optical properties of the transparent sections themselves. Although the optical 
quality prevailing in aircraft glass and plastics was of primary concern to the 
manufacturer of these materials, this factor could not be divorced from design 
considerations because of the limitation in optical quality attainable in both 
glass and plastic transparencies. It was necessary that this limitation be realized 
and taken into account by the designer in order that satisfactory vision be possi- 
ble through the transparent sections of the finished aircraft. 

Frequent complaints were received from flying personnel about the optical 
properties of the transparent materials behind which they flew. Pilots flying 
the A-30 airplane were found to develop motion sickness from observing un- 
dulations of the horizon through distorted windscreens in low level flying. In 
the nose of the early B-i7G's, the complex curvature of the nose and the large 
angle of incidence to the front gunner's line of sight resulted in his seeing two 
targets instead of one in certain directions. In other planes, deviation errors in 
plastic turrets contributed more to the error in the boresighting of guns than all 



308 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

other factors combined. The early B-29S were originally built with curved 
plastic panels in the pilot's compartment. These had to be replaced with flat 
glass to reduce the distortion. Unsatisfactory reports complaining of distortion 
were received from pilots flying C-46's, P-40's, P-51's and A-26's. Most of 
these conditions had to be corrected by altering the angle of the transparent sec- 
tion, its curvature, or position. If, however, they had been anticipated at the 
design stage, it would have resulted in a real saving to the Army Air Forces 
not only in dollars and cents but also in terms of increased visibility for the air- 
crew. Better visibility meant greater combat efficiency and reduced casualties. 

The unsatisfactory conditions reported above were gross defects which 
could be readily seen by anyone. It was not generally realized, however, that 
even minor defects might impair operational visibility seriously. Returning 
combat pilots often stated that the factor of surprise affected the results of com- 
bat to a greater extent than the number of aircraft, performance and armament, 
and that taking the enemy by surprise (or avoiding being taken by surprise) 
depended on the "clearness of view" through cockpit panels. With modern 
high speed aircraft, only a few seconds' advantage in spotting enemy aircraft 
first might mean the difference between combat success and failure. The record 
of this war was replete with accounts of allied aircraft and ground installations 
attacked by our own planes and of enemy planes passed by or mistakenly identi- 
fied. Recognition from a fast-moving plane in the air was an extremely difficult 
task. The differences between Jap Tabby and US O47, Zeke 52 and P-51, Jack 
and Navy F6F, and Takanami Class destroyer and US Fletcher Class destroyer 
were very small and might have easily been obscured by small amounts of dis- 
tortion in the windscreen. 

In view of this, a comprehensive program was initiated to study the desid- 
eratum of transparent sections, which resulted in the formulation of general 
rules regarding methods of improving visibility through transparent sections. 
Studies of the effect of distortion on transparent panels in depth perception 
indicated that although glass quality made a difference, the angle of incidence 
contributed much more to errors in depth perception. 

The following design factors contributed to distortion roughly in the order 
in which they are listed: 

1. The angle of incidence of the line of sight on the surfaces involved. 

2. The degree of curvature. 

3. The optical quality of the surfaces. 

4. The thickness of the glass. 

Aerodynamic advantages offered by transparent areas which were viewed 
at large angles should be considered in relation to the resulting increase in dis- 



RESEARCH AND DEVELOPMENT 



309 



tortion. During the bending operations for glass and plastics, additional varia- 
tions causing distortion were introduced. These variations occurred from one 
individual section to another and were not subject to the degree of control pos- 
sible in polishing operations. These variations also produced enhanced distor- 
tion as the angle of incidence was increased. Even without such variations, 
the optics of a perfect curved section would cause the apparent relative position 
of several objects to be displaced according to the angular relations involved. 
For these reasons, it was necessary that flat panels in those areas used for vision 
in taking off, flying, aiming guns and landing be placed at an angle of incidence 
no greater than 55 0 if Type I, Grade A glass of plastic was used. Curved or 
flat panels of Type I, Grade B quality could be used in those areas only if the 
angle of incidence at any point on the transparent section did not exceed 35 0 . 

During the early months of the war the responsibility for research and 
development of goggles, eye protective equipment and flying sun glasses was 
transferred to the Aero Medical Laboratory. As a result of this, the equipment 
described below was developed and standardized. 

The B-8 goggle was a single lens type of goggle, supplied in the form of 
a kit with interchangeable plastic lenses. It represented an improvement over 
the older B-7 type in that it integrated better with the oxygen equipment and 
restricted vision much less, although still considerably — 31 percent restriction 
of the binocular field and 28 percent of the total field. An electrically heated 
lens for use with this goggle was subsequently developed. It contained adaptors 
for plugging into either the F-i, F-2 or F-3 electrically heated suit* It pre- 
vented frosting of the lens under all conditions encountered in high altitude 
flight down to ~~6o° C, and also assisted in preventing frostbite on the face. 

Flying sun glasses contained a rose smoke lens which transmitted approxi- 
mately 15 percent of incident illumination. This represented a development 
which afforded adequate protection against high intensities. Many earlier 
forms of goggles and sun glasses did not protect from the glare encountered 
in tropical and arctic regions. Further development of the sun glasses was 
represented by the application of a graded density metallic coating over a portion 
of the lens. This offered sufficient protection to permit direct scanning of the sun. 

1. F-i Sun Glass: This item was standardized for use by AAF ground per- 
sonnel in the Arctic. The frame was plastic (with metal core in the temples) 
and a rose smoke lens of about 15 percent transmission was used. The rose smoke 
lens was selected because of the low transmission in the blue end of the spectrum 
and consequent accentuation of light and shadow and of sky and ground in snow 



310 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

covered areas. The relatively low transmission reduced glare from snow fields 
considerably. 

2. F-i Goggle for Dar\ Adaptation: This was a light-weight, leather frame, 
compactly folding goggle with a red plastic lens. It was standardized for use 
as a dark adaptation goggle and as the goggle complement in synthetic blind 
flying training. 

With the increase in night operation which occurred at the onset of World 
War II, it became essential that methods be developed which would permit 
a rapid and reliable classification of personnel upon their ability to perform 
night missions. Several reliable tests were available at that time. However, 
they were not adapted to the mass testing requirement which developed with 
the rapid expansion of the Air Forces. In addition to the time factor, the fact 
that they were unsuited to field use made the development of supplemental tests 
desirable. Two such tests were developed for AAF use by the Aero Medical 
Laboratory. 

The first known as the AAF-Eastman Night Vision Tester was a large 
instrument which tested six subjects at once and required 15 minutes for admin- 
istration. The test period was preceded by 30 minutes of dark adaptation. 
The adaptation could be accomplished by the use of red goggles or a dark 
anteroom. It was possible to test three to four groups of six individuals every 
hour. The AAF-Eastman Tester had certain inherent disadvantages, however. 
It was a large and complex instrument designed for the mass processing of 
personnel. For proper functioning, the apparatus required a relatively perma- 
nent installation in a dark room approximately 30 feet long and had to be 
insulated against excessive vibration or rough handling. 

Inasmuch as these factors made the tester unsuitable for the flight surgeon 
in the field or for general clinical practice, efforts were directed toward the 
development of a small, rugged instrument for use where only an occasional 
test of one or a few individuals was desired. This resulted in the production of 
the Radium Plaque Night Vision Tester, which consisted of a small, portable, 
self-luminous instrument which was impervious to temperature and humidity 
variations, mechanically simple, and easy to use in small dark rooms or tents. 
It was thus ideally suited to clinical or field testing and found widespread 
acceptance throughout the Service. 

Research in ophthalmology at the School of Aviation Medicine, 20 was 
concerned chiefly with the development of vision standards and requirements 
for the various occupational categories in the AAF and the construction of 



RESEARCH AND DEVELOPMENT 



311 



tests for personnel selection. Considerable emphasis was placed on the develop- 
ment of specialized visual equipment needed to train aviators. Important 
problems studied included color vision, night vision, use of penicillin in treating 
eye infections, and the effects of altitude, drugs, and fatigue on visual efficiency. 

Proceeding upon the premise that the usual requirements of rated per- 
sonnel were different because of the mission, the School re-studied the ophthal- 
mological portion of the Standard Form 64 examination, and related stand- 
ards set forth in Army Regulations No. 40-110. The "64" examination required 
knowledge of an examinee's heterophoria and prism divergence power at 20 
feet, plus a convergence near point, to determine his ocular muscle balance. 21 
This exaction did not take into account ability to do close work. Moreover, 
the determination of the convergence near point was thought to be valueless, 
because voluntary convergence can be controlled. 22 It was also suggested that 
prism divergence and heterophoria determinations at 13 inches, as well 
as at 20 feet, should be tested to evaluate individual aptitude for close work. 23 
In using the Maddox Rod to test heterophoria, the School also discovered that 
(a) it made no difference whether the rod was placed before the dominant or 
non-dominant eye (it was suggested for the sake of uniformity, that the rod 
be placed before the right eye), 24 and (b) screening the eye should be omitted, 
in connection with the Maddox test, since the omission would uncover 
exophoria, which was undesirable in an airman. 25 These heterophoria-testing 
revisions were subsequently agreed upon, and a manual written by Scobee was 
adopted in February 1946 by a joint vision committee, in which the Army, 
Navy, and National Research Council were represented. 

Another cause for complaint was the dissatisfaction with existing visual 
acuity test charts. 26 Snellen letters were used, but tests with various sizes of 
letters and dimensions compelled the conclusion that a chart containing a mix- 
ture of all the ideal factors would be extremely unwieldy. Two charts ( AAFSAM 
Visual Acuity Charts Nos. 1 and 2) were arrived at and submitted in September 
1945 to joint authority for possible standardization for the armed forces. 27 

Depth perception being considered one of the prime requisites of pilot 
vision, three existing test methods were examined by Drs. William M. and Louise 
S. Rowland at the School, and a report published in 1944. 28 Ocular prescrip- 
tions were adjusted accordingly and, although other work prevented the com- 
pletion of this project, the partial results were submitted to the joint Army- 
Navy-OSRD Vision Committee in 1945. 29 

Existing methods of color vision testing also came under the scrutiny of 
the School. By December 1942 four color-vision tests were authorized for use 
in the Army Air Forces, together with two adjunct tests. 30 These tests were 



312 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



hardly adequate, however, since half the color deficient individuals to whom 
they were given remained undetected in repeated examinations. 31 A further 
difficulty was the fact that the existing regulations were vague concerning de- 
sired color proficiency; this was partially solved, however, by an analysis of 
jobs in the Flying and Technical Training Commands. 32 

A variety of new color-vision tests came pouring down upon the School. 
One, the Rabkin Polychromatic Charts, was imported from Russia, and, though 
valuable in detecting marked defects, was rejected because of the relative scarcity 
of related materials in this country. A convenient instrument, a modification 
of the Eastman Color Temperature Meter, and costing only $18, was devised 
by Rowland. This instrument, by substitution of one scale which extended 
the testing range, was satisfactory for use as an anomaloscope. 33 Others included 
the Rand Anomaloscope, the ISCC Single Judgment Test, the Eastman Hue 
Discrimination Test, the Farnsworth ioo-Hue Test, and the Peckham Color 
Vision Test. These tests, although possessing many virtues, nevertheless re- 
vealed disadvantages either in availability or range of applicability, and were 
therefore rejected. A series of experiments with a variety of "lanterns" led, 
in January 1943, to the development of a device (Color Threshold Test) for 
measuring chromatic thresholds that furnished not only a quantitative measure 
of ability to recognize aviation signals but also a guide for selecting those indi- 
viduals who, although color-deficient, could nevertheless be regarded as color- 
safe insofar as the recognition of signals was concerned. 34 

The SAM Color Threshold Test differed from other lantern tests in the 
intensity range of its eight test colors which were selected as representative of the 
allowable range for aviation colors and in its method of scoring which permitted 
greater differentiation between normal and color-deficient individuals. 35 

The most suitable tests for screening, apparently, were those of the anomalo- 
scope type and those using pseudo-isochromatic charts — because of simplicity, 
speed with which they could be given, and because a more valid percentage of 
failure was obtained with them than with the other types. 36 A comparative study 
of three tests of these two types — the abridged American Optical Co. Test, the 
Rabkin Test, and the SAM Anomaloscope Test — indicated that any one of them 
would be a very efficient screening device. 

A closely related area of investigation was that of night-vision testing. In 
194 1 the National Research Council authorized a project at Randolph Field to 
study night-vision efficiency. 37 In February 1942, the Air Surgeon, in view of 
the failure of the School of Aviation and civilian laboratories to produce any 
valid instrument, authorized the purchase of 25 NDRC Klopstag No. 2 
adaptometers. This order was subsequently cancelled and an intensified re- 



RESEARCH AND DEVELOPMENT 



313 



search effort was instituted. In 1943, full responsibility for this research was 
vested in the School of Aviation Medicine and the Aero Medical Laboratory. 38 

The intensified research manifested results, as already noted. The Lab- 
oratory, working with the Eastman Kodak Laboratory, devised the Eastman 
Night Vision Tester, which was soon introduced at classification centers and 
gunnery schools. The Eastman instrument, which was capable of testing 6 
to 12 subjects simultaneously, employed a glass plate upon which was repro- 
duced a Landolt ring. This was viewed at a distance of 20 feet by the subject, 
with intensity of illumination diminishing at a constant rate. The test took 
approximately 20 minutes and revealed a coefficient of reliability of 0,797. 
Other night-vision testers experimented with included the Hecht-Schlaer 
Adaptometer and the Portable Night Vision Tester. A comparative study of 
these two and the Eastman instrument resulted in a new system of scoring. 39 
In 1944 Regulation No. 25-2, governing the administration of night vision test- 
ing, was finally amended to incorporate these methods of testing. 40 Tests were 
accompanied by training in night vision improvement. This was especially 
important to night fighter squadrons, then based principally at Orlando, Florida. 
These units received such training with enthusiasm. 41 

This was not all the School did for ophthalmological research; it pioneered 
in the use of penicillin for the treatment of the eye (1944). 42 An attempt was 
made to utilize the glare from the sun to enhance the tactical advantage of our 
fighter pilots, by obscuration against enemy aircraft. 43 Experiments were con- 
ducted on the effect of certain drugs, such as hyoscine and the sulfa drugs, on 
visual efficiency (1942-1944). Hyoscine seemed to have a deleterious result, 
whereas the sulfa compounds did not. 44 

Otology. 45 Research into the effects of high-altitude flying upon the aviator's 
hearing covered the entire hearing mechanism and the sinuses, the effects of noise 
upon these, the treatment of ear infections and an investigation of speech audition 
testing methods. Problems of this nature demanded objective and tested 
auditory standards for aircrews. 

Aero-otitis media, the most serious of the auditory maladies affecting flyers, 
is an inflammation of the middle ear, caused by a relatively negative pressure in 
comparison to outside pressure 46 It is induced by inadequate ventilation of the 
cavity of the middle ear, and improper function of the Eustachian tube. It was 
shown by the School that a pilot who failed to ventilate on descent, after having 
equalized his middle ear pressure at 10,000 feet, would subject his middle ears to 
a pressure of approximately 4% pounds per square inch. 

The effect of altitude changes upon hearing was studied 47 as judged by the 



314 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



audiographs of 54 individuals. It was found that 94 of the total 108 ears were 
affected by either bilateral or unilateral otitic baro-trauma. It could not be told 
from the appearance of the drum, reflecting the vascular and mucosal damage 
of the middle ear, what the degree or type of hearing impairment was, or how 
long recovery would take. 48 Although previous writers had stated the hearing 
loss was only in low tones, 49 evidence pointed to involvement of high tones also. 60 
It was found that repeated exposure to aero-otitis media did not involve any 
permanent auditory impairment 51 

A group of 667 flights was examined, and the incidence of aero-otitis media 
was found to be 18.44 percent. 52 Tuomine (2-amino heptane sulfate) aided in 
reducing this incidence, 53 but the use of either remedial procedures or pressure- 
breathing equipment did not. 54 

The School recommended vasoconstrictor solution and the use of the 
Politzer bag for cases of aero-otitis media discovered after the flight was con- 
cluded. 55 In November 1944, due to the high rate of acute aero-otitis, the 
School was directed to explore techniques of study and control of otitis media 
cases, particularly radium. Results of radium application were inconclusive 
and unsatisfactory. 56 

The War produced a new syndrome, aero-otitis externa, caused by the use 
of inadequately perforated ear-plugs, resulting in vascular damage to portions 
of the auditory canal. 67 

Aerosinusitis which ran middle ear maladies a close second in importance 
was caused by expansion or escape of the gas or air contained in one of the 
sinuses, usually the frontal or maxillary, 58 on flights involving extreme decreases 
of barometric pressure, or, conversely, the opposite reactions occurring on let- 
down. A variant problem was aerosinusitis complicated by tissue obstruction, 
and drastic measures (in one case, a Caldwell-Luc procedure) were taken in 
some instances. 59 The School experimentally produced a case of artificial 
obstructive aerosinusitis in a dog by packing his left nasofrontal duct with 
vaseline gauze, and taking him to 28,000 feet in an altitude chamber. 60 The 
lesions thus produced were similar to surgically excised mucosa of a human 
maxillary sinus. Although the symptomatology of aerosinusitis was different 
from purulent or catarrhal sinusitis, because of the acuteness of needle-like 
pain, cases of aerosinusitis could be transmuted into purulence. 61 

In hot, humid areas, airmen soon began to suffer from external otitis, a 
malady attributed to a fungus, but whose cause is not definitely known. 62 
Senturia, at the School, formulated an etiological classification of this disease. 
Since the possible causative bacilli were many and varied, he attempted to 
find strains or combinations of these which might be taken seriously. He 



RESEARCH AND DEVELOPMENT 



315 



found none. Sulfa compounds proved to be inhibitory to these fungi, but 
penicillin did not act in a successful manner. 63 

Concurrent with these studies, otolaryngologists at the School were also 
considering noise and its effects on hearing. In 1942 and in 1943 Senturia 
attacked the problem of whether aircraft noise permanently impairs hearing. 64 
His investigations revealed no noticeable permanent high-tone losses in the 
cadets and trainees he observed. If there were any such losses during flight 
training, they were apparently, to a large extent, recovered after that period. 
The relative acoustical merits of the B-17, B-24, and B-29 were investigated, 
and the B-29, because of its superior soundproofing, was judged the best. 

In its investigations of examination standards for hearing, the School of 
Aviation Medicine concluded that the recorded spoken word test was as good 
as the audiogram; but that the conventional whispered word test was superior 
to the spoken word test, inasmuch as the former attained a greater range of 
auditory frequencies. 65 

Aviation Dentistry.™ The first appearance in print of a serious study in 
aviation dentistry was as early as 1918, when Fischer suggested that models of 
flyers' jaws should be made early in flying training. 67 The interval between the 
two wars saw studies by Americans and others, made on dental foci of infection, 
injury to and loss of dental restorations, dental identification records, the 
interrelation between aero-otitis media and malocclusion, salivation, and tooth- 
ache at altitude. 

Col. George R. Kennebeck (DC) in 1943 began a systematic inquiry, by 
questionnaire, on the relationship between dental and oral tissues and high 
altitude. Necessity for comprehensive co-ordination of military dental authority 
in reaching significant conclusions in aviation dental research led to the con- 
vening of the First Conference on Aviation Dentistry 68 in February 1945, 
followed by succeeding conferences and the establishment of working ententes 
with such other government agencies as the Navy and OSRD. 69 

Although a correspondent pointed out as early as 1940 that Royal Air Force 
flyers experienced toothache at altitudes of 25,000 feet, 70 experimental work on 
the effect of altitude upon the teeth of airmen did not begin until 1943. 71 
Mitchell, of the School of Aviation Medicine, was responsible for initiating the 
use of the word "aerodontalgia" in 1944 to describe toothache at altitude. 72 
The sum of aerodontalgic research seemed to show that while toothache at 
altitude varied in severity and duration, it depended on some previous patho- 
logical disturbance in or around the tooth, complicated by aero-embolism and 

262297°— 55 22 



316 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

local tissue anoxia. The number of aerodontalgia cases in decompression 
flights tended to be between i and 2 percent. 73 

Freitag, for the Luftwaffe/ 4 proved experimentally that cold had no appre- 
ciable effect on the teeth. This finding was contemporaneously corroborated 
by Harvey, in England, 75 who recommended the use of a sharp burr in a slowly 
running handpiece under a cooling stream of water or air to avoid pulpal 
reactions predisposing to toothache at altitude. Again, Freitag 76 showed that, 
at altitude, expanding gas in a root canal could force material through the 
apical foramen, thus engendering a source of infection. 

Did centrifugal forces have an effect on the teeth ? Authorities disagreed. 
Based on experiments conducted among Royal Norwegian Air Force pilots, 
Sognnaes 77 found no such relationship; but Harvey thought otherwise. 78 How- 
ever, on the possibly painful effect of trapped air under a filling, during decom- 
pression, most experts agreed that there was no such injury. 79 The same 
conclusion was reached on the possibility of aeroembolism as a cause of 
toothache. 

In certain altitude toothache cases, devoid of detectable dental pathology, 
it was reasoned that the cause might be an obstruction of the maxillary ostia, 
making it difficult for the air pressure in the maxillary sinuses to become 
equalized with changing atmospheric pressure. 80 In related cases, it was con- 
cluded that pain which seemed to be dental was apparently an oblique mani- 
festation of aerosinusitis. 81 

Most of the studies in dental histology were made in this country. The 
first study 82 concerned itself with the results of seventy-five extractions after 
a decompression flight. Some pulps showed a typical edema without inflam- 
mation; in two cases, large spaces were seen in the pulp horns. Seventeen 
teeth showed varying degrees of acute inflammation of the pulp, and numerous 
empty spaces were detected in several of these. Another study of the fillings 
and pulps of dogs subjected to a chamber flight 83 showed definite changes in 
the pulps, presumably due to decompression or anoxia. 

Just as in ordinary cases, it was difficult in aerodontalgic cases to deter- 
mine the exact source of pain. It was shown that recently filled teeth were 
the worst offenders. Pain might be detected by X-ray, electrical pulp testers, 
thermal tests, or ice. 84 The etiology was determined to be based chiefly on 
the existence of some pathological disturbance of the pulp or periapical tissues, 
excited by an unknown mechanism peculiar to high altitude flights. 85 

Willhelmy continued his studies of aero-otitis and mandibular malposition 
during the War. 86 Movement of the mandible was reported by Brickman and 
Bierman 87 to be the most efficient means of counteracting "ear block" during 



RESEARCH AND DEVELOPMENT 



317 



recompression. It was theorized that malposition of the jaws influenced aero- 
otitis, but Harvey 88 vigorously denied this assumption based on experiments 
in which he participated. 

The effects of low barometric pressure on good and bad fillings were inves- 
tigated. In 30 cases out of an experimental total of 115, an air space was 
provided to see if by expansion of this air, the filling could be displaced during 
decompression. No displacement occurred, but subsequently it was shown 
that oral liquids could be insinuated into faulty fillings. 89 Oxidation of gold 
restorations was reported by one investigator 90 and two others 91 contrived 
to disturb the calcification of the dentin of rats during experiments. Vibra- 
tions of varying intensity failed to produce perceptible results on the teeth of 
white rats. 92 

Sognnaes studied the effects of acceleration upon removable prosthetic 
dentures, and recommended fixed bridges or thin, light, properly retained re- 
movable appliances. 93 In another experiment it was shown that at 30,000 feet, 
measurable retainability of dentures was reduced by 50 percent of sea level re- 
tainability. 94 There were complaints from the field that airmen were forced 
to remove their dentures because of tight oxygen masks, and there was a conse- 
quent modification of mask design. 95 

On examining some 7,000 aviation cadets, it was discovered that the DMF 
index (D = decayed; M = mission or requiring extraction; F = filled) corre- 
lated geographically with regions having endemic fluorosis. 96 Saliva specimens 
were collected in the case of 27 men breathing pure oxygen at simulated alti- 
tude, and compared with pre- and post-trial specimens. No appreciable differ- 
ences were detected. 97 

The treatment of bleeding gums was attempted unsuccessfully by the British 
with ascorbic acid, on the postulation that diet was an important factor. 98 A 
dental survey of 500 fighter pilots showed an incidence of periodontal disease 
of 29.2 percent, caused chiefly by sumptuary living and certain dental pressure 
habits while on flight. 99 4 

The end of the war left many dental research matters unsettled. Among 
them were: 100 

(1) Thorough investigation of the relationship of the temporo-mandibular joint to the 
problem of aero-otitis media. This could be accomplished concomitant with further neces- 
sary work on temporo-mandibular joint disturbances as related to head and neck neuralgias, 
tinnitus, and other symptoms of this syndrome. 

(2) Histopathologic studies of the pulps of teeth afflicted with aerodontalgia, and the 
normal pulp and gingival tissues subjected to decompression and anoxia. Using these tissues 
as readily available biopsy material, there is a possibility that information about the effects 
of these conditions on the tissues throughout the rest of the body may be obtained. 



318 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



(3) A study of maxillofacial injuries received in aircraft accidents; causation, treatment, 
results, and perhaps prevention. 

(4) A laboratory investigation of dental foci of infection under conditions prevalent 
in flying. 

(5) The development of an accurate gingival shade guide to be used to study the 
possible relationship between gingival manifestations and anoxia, decompression, and flying 
fatigue. 

(6) Gnathodynamometric studies of the extensive occlusal stresses which are known 
to occur during flight maneuvers. 

(7) Further studies of the effects of flying conditions on the chemical, bacterial and 
physical qualities of saliva. 

Air Sickness. 101 Air sickness is a variant of motion sickness, to which no one 
is apparently immune. In the Army Air Forces, it was found that the problem 
was most serious during training; when once a pilot reached combat, he was 
generally free of the ailment. 102 The interest in air sickness arose during World 
War I, and in the period between the wars conflicting theories of causation and 
remedy arose. At the outbreak of the Second World War, extensive Canadian, 
British, Russian, and American research was conducted ; at the School of Avia- 
tion Medicine, this research was at first administered (from the summer of 
1942) by a Motion Sickness Committee, with Col. P. A. Campbell in charge. 
Later work was entrusted to Hemingway and Smith. 103 

Motion sickness is caused by motion or mental suggestion of motion, and 
varies with the patient. Some authorities attempted arbitrarily to classify 
air sickness as a neurosis, but the two afflictions might or might not coincide. 104 
The sequence of sympoms is: 

(1) Drowsiness. (5) Vomiting. 

(2) Nausea. (6) Alkalosis and ketosis. 

(3) Pallor. (7) Tremor and rigidity. 

(4) Cold sweating. (8) Headache and dizziness. 

No known explanation for drowsiness was developed. Research in this 
area, however, was the opening gun in the progressive attack on air sickness. 105 
Since "a breath of cool air" had always been prescribed for seasickness, the 
efficacy of this traditional remedy was tested in 1943. There appeared to be 
no appreciable connection. 106 The previously postulated assertion that there 
were significant blood pressure and pulse changes during motion sickness was 
carefully investigated and found to be without basis in fact. 107 

Studies were made of the rates of air sickness during various stages of flying 
training. 108 In preparatory work at college training detachments, results of 
over 26,000 flights were examined, and it was found that air sickness occurred 



RESEARCH AND DEVELOPMENT 



319 



on 2.46 percent of the flights; the incidence of air sickness decreased over 4 
percent between the initial and the terminal flights. 109 In primary training, 
there was a higher percentage of air sickness among those eliminated than 
among graduates. 110 Among navigators, the occupational singularity existed 
that many students could be air sick and still continue with their duties. Accord- 
ingly, as high as 65 percent of navigator graduates were air sick. A study was 
made in 1943 of the incidence of air sickness among bomber crews, and ap- 
parently the greatest number of cases occured among navigator-bombardiers 
and radio-gunners. The high incidence of air sickness in combat crew training, 
ranging from 11 to 19 percent, was surprising. 111 The effect on airborne troops 
was also investigated; about one man in seven was incapacitated, and one in 
four was air sick. 112 

Because air sickness so crippled military operations, the School turned to 
the problem of devising suitable selection criteria. Until 1942 Army Regula- 
tion No. 40-110 stipulated rotation in the Barany chair, on the supposition that 
the labyrinth was the source of air sickness. This was a false postulate, because 
evidence soon became available that it was excessive stimulation of the utricle 
rather than the semi-circular canals of the labyrinth which caused motion sick- 
ness, and the Barany chair stimulated the canals. As a result of these findings 
the Barany chair test was discontinued, but in 1943-44 an investigator at the 
School believed that a modified Barany Chair Test would be valuable. An 
attempt was made at the School to use X-ray plates to determine air sickness 
predispositions, but this was unsuccessful. 

One of the most satisfactory tests in use at the School was the swing test, 
employing a swing with a twelve- to fifteen-foot radius. 113 This had the 
advantage of known and controllable laboratory factors. Statistically, it was 
proved that susceptibility to swing sickness normally meant susceptibility to air 
sickness. 114 

The basic problem giving the Air Force concern was the selection of those 
potentially air sick cadets who could nevertheless fly successfully and the elimina- 
tion of air sick cadets who failed at flying. It was shown that air sickness did 
not necessarily incapacitate flying personnel, although many psychiatrists be- 
lieved that air sickness and psychoneurotic tendencies were often associated. 115 
The problem of selection was further complicated by the fact that the swing 
test and follow-through of individual case histories of several subjects did not 
enable distinction between those who were subsequently able to overcome their 
air sickness and those who remained chronically susceptible. It was concluded 
that all the psychological factors acting upon student and instructor needed 



320 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



evaluation before a satisfactory method of selecting for susceptibility to air 
sickness could be achieved. 116 

Could drugs aid in preventing air sickness? Many were tested at the 
School. Sodium barbital, Vasano (a proprietary drug), benzedrine, a new 
thiobarbiturate, thiamine, and pyridoxine did not help. 117 

In 1942 hyoscine experiments were started. Hyoscine hydrobromide in 
doses of 0.5 mg. and 0.75 mg. 118 decreased the incidence of swing sickness. The 
U. S. Army Motion Sickness Preventive, containing hyoscine, atropine, and 
sodium amytal, was also moderately effective. 119 A comparative test of remedies 
at the AAF Navigation Schools at Hondo and at San Marcos also demonstrated 
the moderate effectiveness of these remedies as well as of the Royal Canadian Sea 
Sickness Remedy and hyoscine used alone. 320 In a final survey of the drug 
problem, it was concluded that hyoscine was the best. 121 

Neuropsychiatry} 22 Most of the work in this field at the School was con- 
cerned with improving the neuropsychiatric portion of the examination for fly- 
ing. In 1941 the psychiatric examination was conducted on an intuitive, hap- 
hazard basis. 123 One of the first wartime school projects in neuropsychiatry was 
the consideration of the electroencephalograph as a possible means of improving 
selection of cadets. A three-channel glass apparatus was used, and on a marking 
scale ranging from one to five, relative success or failure in flying was success- 
fully predicted in 83 to 86 percent of all cases, in a preliminary evaluation. 124 
However, in examining more cadets in this manner, and submitting their elec- 
troencephalograms to Gibbs and Davis of Harvard, and Goodwin (RCAF), 
the results proved inconclusive. 125 Use of the photoelectric plethysmograph in 
measuring pulse reactions to startle was likewise unsatisfactory. 120 

Eight hundred officers were somatotyped through application of the prin- 
ciples of constitutional psychology and anthropometry at Kelly Field and at the 
San Antonio Aviation Cadet Center in 1942-1943, and accuracy was achieved 
in approximately 80 percent of instances. 127 In examining the efficacy of this 
approach more closely, results were likewise inconclusive, although the anthro- 
pometric photographic negatives had several other valuable scientific uses. 328 
Attempts were made from 1943 to the end of the war to predict flying ability 
from analysis of Rorschach tests, but were interrupted by transfer of examining 
physicians and other pressing matters. 

One type of measure, first introduced in 1941 on a research basis at the San 
Antonio Aviation Cadet Classification Center, was a single coordination test, 
given orally. On the basis of this early trial, such a test was standardized and, 
in 1943, was introduced at the Classification Center for use in detecting the 



RESEARCH AND DEVELOPMENT 



321 



grossly abnormal individuals. 129 The test itself was apparently successful in 
discriminating the latter from the less maladjusted; however, tvhen these 
abnormals were referred for treatment it was generally to physicians untrained 
in psychiatry and the program consequently fell short of its complete objective. 130 

In April 1943 a long-range project utilizing the Minnesota Multiphasic 
Personality Inventory (M. M. P. I.) was begun in an effort to determine emo- 
tional changes in pilots with particular attention devoted to incidence of acci- 
dents and disciplinary actions. 131 Although this survey was not complete, avail- 
able material proved valuable in detecting hidden basic emotional factors. 132 

The School also examined certain problems in connection with neuropsy- 
chiatric standards contained in Army Regulation No. 40-110. With respect to 
muscle atrophy, it was concluded that it had no relation to strength for aircrew 
training, except when the atrophy interfered with the ability of the neuro- 
muscular system efficiently to move joints, or indicated a progressively disabling 
disease. 133 Cadets from broken homes made as good flyers as those from unim- 
paired environments, but were subject to more rapid "operational fatigue." 134 
Cadet applicants who fainted, it was decided, were not necessarily nervously 
disturbed in a chronic manner, but their applications were carefully studied. 135 
A manifestation of enuresis was found to be disqualifying. 136 

In May 1944 the School of Aviation Medicine undertook responsibility for 
investigating the possibility of developing a battery of objective tests that might 
be useful as a screening device aimed at reducing the psychiatric casualties of 
combat. 137 The Air Surgeon opposed the use of already available psycho- 
physical devices (spirogram, Strogin-Hinsie apparatus, photoelectric plethysmo- 
graph, ophthalmograph) because of lack of validity data. He urged, instead, 
that a series of paper-and-pencil tests be developed and that attention be given to 
what happened to the individual after he learned to fly, and particularly during 
combat. In July 1944 the Neuropsychiatric Research Program was in full plan- 
ning stage and in January 1945 authority was granted to initiate testing at Dale 
Mabry Field, Florida. 138 It was an ambitious program, utilizing specially de- 
vised paper-and-pencil tests, a standardized 2-hour psychiatric interview, and 
a round table interview, with follow-up case-history interviews during combat 
overseas. 139 Because of opposition of local commanders, however, and the lack 
of civilian consultative assistance, certain phases of the program had to be 
abandoned, 140 and, finally, on V-J Day, after having secured 725 interviews, the 
project was abandoned. 

Several other interesting and valuable conclusions were reached during the 
course of neuropsychiatric research. By use of the electroencephalograph, it 
was determined that carbon dioxide could be substituted at 35,000 to 45,000 



322 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



feet for 10 percent oxygen in masks with no impairment in efficiency. 141 
Attempts were made to associate electroencephalograms with cerebral reactions 
to drugs. Atabrine dihydrochloride and the anti-malarial drugs SN-6911 and 
SN-7618 were tested, but no relation was found. 142 Likewise, in the interests 
of expanding neurological knowledge of head injuries, electroencephalograms 
were taken after several such cases, but it was decided that nothing especially 
valuable was gained in this manner. 143 

By September 1943 the School's psychiatry laboratory staff participated 
in pilot interviews held before the Randolph Field Evaluation Board, with 
a view to investigating psychopathologic reactions to aircraft accidents, pre- 
viously determined to have been the primary source of fear of flying. These 
reactions were characterized as phobia with an anxiety fixation to an indifferent 
circumstance surrounding the original trauma. An interesting factual by- 
product of these studies was that flyers thus affected often rationalized their 
affliction and tended to remain on flying status longer than conditions 
warranted. 144 

Psychology. One of the major contributions of the Army Air Forces in 
World War II was the development of an extensive battery of examinations for 
the testing and classification of aviation cadets. The program was developed 
under the direction of Col. John C. Flanagan of the Air Surgeon's Office, 
Headquarters, AAF, and Dr. A. W. Melton, Chief of the Department of 
Psychology at the School of Aviation Medicine. The details of this program 
have been discussed in detail elsewhere; therefore only one project — the 
Psychomotor Test Research Program — is described here as being illustrative of 
the program. 145 

The origins of this program reach back to August 194 1, when the School 
of Aviation Medicine and the Air Surgeon simultaneously began to recruit 
research psychologists and apply their work to personnel selection and induction 
procedures. 146 After a conference between Colonel Armstrong, Director of 
Research at the School, Melton, then of the University of Missouri, and Maj. 
John C. Flanagan, aviation psychologist in the Office of the Air Surgeon, it was 
decided that the development of studies in this field would be centered at the 
School, with associated testing to be carried on at the Psychological Research 
Center at Kelly Field. In October 194 1 another conference was held at the 
Research Center at Maxwell Field, with Flanagan and Maj. R. T. Rock of the 
Office of the Air Surgeon, Melton of the University of Missouri, and Dr. Robert 
Seashore of Northwestern University, in attendance. There it was decided to 
introduce, on an experimental basis, at Psychological Research Unit No. 1, the 



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323 



Complex Coordination Test, The Rotary Pursuit Test, the Seashore Visual 
Discrimination Reaction Time Test, the Seashore Arm-Hand Swaymeter, and 
the Seashore Photoelectric Aiming Test. 147 

In February 1942 the Air Surgeon's Office assumed responsibility for the 
program of selection and classification of aircrew personnel (pilots, bombard- 
iers, and navigators). This entailed, in addition to carrying out research, the 
selection of particular tests and equipment to be employed at AAF classifi- 
cation centers. 148 The Psychology Department at the School, activated by Dr. 
Melton in March 1942, was assigned responsibility for developing and obtain- 
ing psychomotor equipment and for validating experimental tests. 149 

After a period of indecision as to the respective functions of the School of 
Aviation Medicine and the classification centers, the situation was clarified 
by establishing the construction of psychomotor tests as the primary respon- 
sibility of the School and the administration and statistical analysis of tests 
as the function of the centers. 150 

The first psychomotor test battery had already been put together at the 
School before the definitive clarification of functions was announced. This 
battery — SAM Complex Coordination Test, Two-Hand Coordination Test, 
Koerth Rotary Pursuit Meter, a Modified Miles Pursuit Meter, the Accelerated 
Test (a modification of the McDougall Dotting Test), and one form of a 
Discrimination Reaction Time Test — was later changed to consist of SAM 
Complex Coordination Test, SAM modification of the McFarland-Channel 
Two-Hand Coordination Test, SAM modification of the Koerth Rotary Pur- 
suit Test, Discrimination Reaction Time Test, a Steadiness Test, and a Finger 
Dexterity Test. 151 The construction of this initial battery, of course, required 
a determination of the optimum testing conditions and the reduction to a 
minimum of non-standard testing conditions, as well as a variety of design 
and production problems. All the tests, with the exception of the Rotary 
Pursuit Test, were eventually standardized and introduced at Psychological 
Research Unit No. 2, Kelly Field, Texas, in late 1942. 

During 1942-45, continuous modifications and improvements in the vari- 
ous tests of the battery were accomplished and much effort was expended on 
establishing national norms for the tests. When Headquarters, AAF, in June 
1943, increased the number of classification centers from three to ten, sixty 
new units of each test were prepared. 152 Later, four modifications of the Com- 
plex Coordination Test were effected and the Discrimination Reaction Time 
Test was made self-paced and automatically scored. 153 The use of the Rudder 
Control Test in the testing centers immediately revealed a need for new models 
to increase dependability and in 1944 several new models were introduced. 104 



324 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

The final tasks of the Psychology Department in the development of classifica- 
tion psychomotor tests were devoted to the selection of B-29 gunners and a 
test for this purpose was completed in April 1945. The test was not used 
for classification purposes until June of that year and, after mechanizing the 
scoring, it was introduced at the AAF Military Training Center, San Antonio, 
Texas. 155 It may be said that the psychomotor tests developed by the Psy- 
chology Department of the School made significant contributions to the 
selection of successful pilots, bombardiers, and navigators. 

During the period of this history, considerable energy was expended at the 
School and at the Aviation Cadet Center on testing and validating other instru- 
ments than those included in the classification battery, in an effort to find 
superior replacements for the standardized tests. Experimental validation test- 
ing was generally performed with large groups (500 to several thousand) of un- 
classified aviation students and immediately after these had been given the stand- 
ard battery. In this way, satisfactory requirements were met for obtaining ade- 
quate validity data. 156 The experimental activities of this sort carried on at the 
School fell into four periods: (a) from January to August 1942, tests administered 
were for the most part borrowed from civilian institutions; (b) from November 
1942 to April 1944, tests were produced by the School, with pilot or bombardier 
selection in mind as auxiliary tests; (c) from May 1944 to May 1945, tests had the 
same genesis as in the immediately prior periods, but were administered at pre- 
flight school; (d) and from March through August 1945, tests devised for a 
special Navy project which never materialized. 

During the first period, the Complex Coordination Test, Koerth Rotary 
Pursuit Test, and McFarland-Channel Two-Hand Coordination Test were ex- 
amined for validation and procedure. In addition, five other tests were ex- 
amined and found wanting; indeed, none of these, except the Two-Hand Co- 
ordination Test, proved of sufficient validity to warrant continued experi- 
mentation. 

During the second period, the School turned its attention to a battery of 
tests measuring visual-motor pursuit functions, including a non-rhythmic pur- 
suit test which contrasted with the rhythmic pursuit function measured in the 
Rotary Pursuit Test. Variants of this test simulated different uncomplicated 
elements of pursuit testing, combined in the SAM Multidimensional Pursuit 
Test, 157 which reproduced simultaneous stick, rudder, and throttle testing, and 
which proved a lasting contribution of the School in this area. 

Early in 1944 the Link Trainer, a device for assessing pilot aptitude, and 
related equipment was tested for possible inclusion in test batteries by flying 
the trainer so that a beam of light projected from in front would fall on sta- 



RESEARCH AND DEVELOPMENT 



325 



tionary photo-electric targets. 158 A number of different test uses of the trainer 
served as a basis for scoring. 159 It was also determined that muscular tension 
during the course of many tests was no guide to flying success. 160 Another 
group was unsuccessful in its attempt to relate visual coincidence — speed in 
stopping hands of a calibrated stop-clock — to pilot or bombardier proficiency. 161 
The third period saw the testing of already used devices as well as certain 
new instruments devised by the School's Department of Psychology or by per- 
sonnel of Psychological Research Unit No. 2. 162 All the tests were administered 
to unclassified or classified students in pre-flight school. The data obtained, as 
a consequence, were conditioned by the fact that all the testees were already 
aware of their final flying classification. Also, data were not comparable to 
previously obtained statistics, since stanine requirements for pilot selection had 
grown more rigorous. 163 Of greatest interest were the tests involving simple 
and complex timing reactions. In two varieties of these — Simple Hand or 
Foot Timing Reaction Test and Memory for Procedures Test — the subject was 
required to roll a ball over a designated area with prescribed controls. Another, 
the Stability Orientation Test, measured accuracy of space orientation. Final 
analysis of data on many of these tests had not been accomplished by the end 
of the war. 164 

The fourth period of research, as already indicated, involved a Navy pilot 
testing project which never got under way. Certain tests, however, developed 
for the project (Self -Pacing Discrimination Test, Multidimensional Pursuit Test, 
Controls Orientation Test, Airplane Control Test) were earmarked for use in 
the postwar validation testing program of the School of Aviation Medicine. 165 

Research in Physical Fitness™ Studies undertaken at the School on the 
general medical section of the physical examination for flying were concerned 
with (i) vasomotor instability, (2) blood pressure determinations, (3) use of 
the electrocardiogram to detect heart disease, (4) measurement of thoracic 
and abdominal circumference, and (5) validation of physical requirements 
for flying. These considerations were later supplemented by experiments to 
attempt prediction of G-tolerance. 

Fifty unsuccessful cadets, and 30 pre-primary cadets, were examined 
for evidences of vasomotor instability, based on such indications as pulse rate, 
blood pressure liability, and Schneider Index. Vasomotor instability was found 
among 20 percent of the unsuccessful cadets and 33 percent of the pre-primary 
cadets. 

The Schneider Index was discontinued as a measure of vasomotor insta- 
bility in 1944 as a result of the School's inquiries into its validity. Statistics 



326 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



showed that it bore little relationship to actual success in flying, 167 and was 
deficient in several other respects, notably in its inconsistency in individuals 
with organic heart disease. The Index was replaced by an orthostatic tolerance 
test. 168 

The School also looked into the method of recording blood pressure, paying 
particular attention to two controllable factors, the position of the arm and 
the amount of congestion in the extremity when the blood pressure is recorded. 
The School's investigations indicated that (i) the blood pressure should always 
be determined with no part of the arm below the level of the heart (5 cm. 
below the sternal angle), regardless of position, (2) when blood pressure is 
determined with the arm at heart level, the average effect of draining the arm 
of venous blood is negligible, (3) there is a positive correlation between thick- 
ness of the arm 10 cm. below the epicondylar line and the level of the diastolic 
blood pressure, and (4) from data available elsewhere, it is obligatory to make 
all comparative determinations on the same arm. 169 

Two additions to the physical examination, presumably the result of the 
School's effort, were: examination of the carotid sinuses of all individuals who 
gave a history of fainting without adequate cause, and rejection of all examinees 
who had a history of sensitivity to motion. 

A survey of chest and abdominal measurements 170 showed that they were 
unreliable, and after concluding that the variables — due, for the most part, to 
divergences in human judgment — could not be controlled, 171 the School recom- 
mended that this requirement be excluded from the examination, especially 
since, by themselves, these measurements were never employed as disqualify- 
ing criteria. 

During the war, examining physicians were strict in the evaluation of 
potentially progressive diseases. This was because in the case of pulmonary 
tuberculosis, for example, there was a possibility that exposure to altitude 
might activate acid-fast infection. Rheumatic fever was treated in the same 
manner, except for recurrences 6 months after infection. In the latter cases, 
each case was considered individually, as in the instance of potentially progres- 
sive degenerative diseases, particularly of the cardiovascular system. 172 A 
liberal interpretation of electrocardiograms, correlating them with other data 
available, by flight surgeons who were cardiac specialists, was recommended 
by the School. 173 

Validation of the physical requirements for flying was attempted by admin- 
istering the "64" examination to civilian pilots applying for jobs as "trainee 
instructors" with the Gulf Coast Training Command (April 1943). Despite 



RESEARCH AND DEVELOPMENT 



327 



the fact that the mean solo time of applicants was 212 hours, many were 
rejected for visual and skeletal defects. In view of the fact that these were 
successful civilian aviators, possible revision of physical standards was 
indicated. 174 

Lastly, an attempt was made to establish standards by which G-tolerance 
could be predicted, but the results were inconclusive. 175 By the end of the war, 
only individuals with marked orthostatic hypotension who were unable to 
endure the force of gravity could be detected. 

The Laboratory of Physical Fitness, Research Division, was organized, as 
an AAF directive stated, "for the purpose of improving methods and techniques 
for the development and measurement of the physical fitness of AAF per- 
sonnel." 176 Early in 1942, nine typical AAF installations were visited, and the 
conclusion was that although the theory was good, the practical application of 
the theory was poor. 177 One particular complaint was that there were few 
games presented, thus not employing the spirit of competition in support of 
morale; calisthenics were condemned as too antiquated. The Laboratory 
eventually developed a set of exercises known as "aviation calisthenics," 1<8 which 
simulated a plane and pilot in action. 

As a result of this installation survey, AC/AS-3, Training, Headquarters, 
AAF, designed a test consisting of sit-ups, pull-ups, and a 300-yard shuttle run 
on a lane 60 yards long. 179 Although a test-retest correlation showed high relia- 
bility, this test came under fire, and, in April 1943, at the direction of the 
Air Surgeon, the two chief competitors in the field, the Behnke and Harvard 
Step-up Tests, underwent trial at the School. 180 A comparison of results indi- 
cated that the AAF test was the superior. 181 Somewhat later, two attempts to 
include breath-holding 182 and Palmer skin resistance 183 in the AAF test were 
rejected when it was demonstrated that these factors had little relation to 
physical fitness. 

In December 1943 the School was directed to look into the physical training 
program of patients convalescing at AAF hospitals with the view of increasing 
manpower utilization. 184 Accordingly, patients were divided into groups, and 
subjected to diverse gradations of exercise, including progressive step-up exer- 
cises 183 culminating in a running exercise. 186 As a result of this investigation, 
it was found that most patients could safely begin ward exercises on the second 
afebrile day. It was also found at the AAF Regional Hospital, San Antonio 
Aviation Cadet Center, that there was a temporary increase in the sedimenta- 
tion rate of the red blood corpuscles after vigorous exercise. 187 These facts were 
especially applicable to rheumatic fever patients. 188 



328 MEDICAL SUPPORT OP THE ARMY AIR FORCES IN WORLD WAR II 



The relationship of physical fitness to flying ability was also investigated. 189 
It was found that cadets with poor coordination were evidently eliminated in 
primary school. It was discovered, also, that physical fitness was not related 
to aero-embolism susceptibility, nor did a decrease in physical fitness result 
from preventive doses of sulfadiazine and SN-7618. 190 

In June 1944 the School was asked to develop a series of exercises designed 
to facilitate relaxation. 191 These were sought as a possible preventive of psycho- 
neurosis, inasmuch as the latter disability manifested a large increase with the 
advent of combat. Such exercises were accordingly drawn up. 

Bacteriology and Preventive Medicine} 92 In January 1945 the Air Surgeon 
felt the need for a bacteriology laboratory at the School and accordingly trans- 
ferred the Laboratory Service at the AAF Regional Hospital, Scott Field, Illinois, 
to the School of Aviation Medicine. In the pursuit of the elusive bacilli of 
infectious disease, this laboratory not only continued its previous work on peni- 
cillin at Scott Field, but also studied diarrhea 193 and streptococcus infections 
(including the resistance offered to penicillin by strains of streptococci). 

The first problem facing -the laboratory on its assumption of the studies 
of penicillin, in order to enhance the therapeutic value of this drug, was how 
to slow down the rapid absorption of penicillin into, and expulsion from, the 
human body. Various investigators approached this problem in many ways — 
one, by modifying the penicillin molecule to produce water-soluble derivative; 
another by suspending the penicillin in a non-aqueous medium in which the 
penicillin salt was insoluble; and a third, by suspending penicillin in mixtures 
of peanut oil and beeswax. 194 This last method proved itself the most successful. 
Experiments later showed that addition of a vasoconstrictor-like neosynephrine 
approximated the beeswax method in results. 195 The neosynephrine method 
was tried on a number of male patients with gonorrhea urethritis, and after 
a lapse of 3 weeks' observation, 77 percent were cured. 196 

It had long been known that penicillin was useless when taken orally in nor- 
mal dosage. With the inability of sulfonamide to cope with streptococci and the 
increasing possibility of a pandemic, the laboratory began to cast about for the 
truth about oral absorption of penicillin. From investigations, it was concluded 
that the best time for the oral administration of penicillin was in the fasting 
state and that if penicillin were administered after mealtime, the inclusion of 
antacid would be markedly beneficial. Furthermore, if oral penicillin were 
used, five times as much oral as parenteral penicillin would have to be admin- 
istered to be effective. These statements were clinically tested by using oral 
penicillin against gonorrhea fortified by trisodium citrate to counter the ravages 



RESEARCH AND DEVELOPMENT 



329 



of eating. The results indicated 93 percent of 48 patients cured by a total dosage 
of 500,000 units, and 88 percent of 17 patients cured with half this dosage. 197 

The bacteriology laboratory also investigated penicillin esters, particularly 
the N-butyl ester. Although in mice the ester seemed to be converted into free 
penicillin and remained chemotherapeutic and non-toxic, administration to 
human beings was not so successful, apparently because human tissue could not 
convert the ester. 198 

Another penicillin study undertaken by the Laboratory was to determine 
relative sensitivity of hemolytic streptococci of human origin to penicillin. 
Serological classification of streptococcus strains was arrived at, 199 and results 
generally encouraged the conclusion that this type of streptococcus was not 
developing resistance to penicillin. A study which was incomplete at the end 
of the war was an attempt to probe into the effects of detergents on penicillinase, 
an enzyme inimical to penicillin. 200 

In May 1945 the AAF Central Diarrheal Disease Control Program was 
established at the School, with use of the bacteriology laboratory. This facil- 
ity was to isolate and study Salmonella and Shigella strains, especially among 
combat returnees, and was to investigate any serious outbreak of diarrhea in 
the United States. 201 The program lasted until November of that year. In order 
to provide mass training in salmonella laboratory techniques, the cooperation 
of the head of the National Salmonella Institute at Lexington, Kentucky, was 
secured. 202 Unfortunately, few demonstrable results could be obtained because of 
a jurisdictional dispute between the Diarrhea Program coordinator and the chief 
of the Bacteriology Laboratory. 203 Fragmentary data from personnel centers 
at Keesler Field and in Miami, however, indicated that infections reported 
were of local origin. 204 One valuable finding made by the Laboratory was that 
S.-pullorum, previously doubted to be a source of human gastro-enteritis, was 
definitely isolated in human patients during an outbreak at Chanute Field, 
Illinois. 205 In an effort to reduce the time and possibility of error in salmonella 
tests, the National Salmonella Institute, through the Office of Scientific Research 
and Development, investigated the possibilities of polyvalent Salmonella sera. 206 
These sera appeared to be successful in reducing intervening time intervals and 
the possibility of inaccuracy. 207 

The Bacteriology Laboratory, having in mind that the Navy 208 had shown 
that sulfadiazine administration to troops had reduced their respiratory disease 
rates, attempted to uncover another agent not so toxic in its collateral effects. 
Sulfapyrazine was accordingly tried at Scott Field, and the results were not 
appreciably different from sulfadiazine. 209 Another minor investigation con- 



330 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



cerned itself with the bacteriology of external otitis. Here Pseudomonas 
aeruginosa was suspected, but never proved as the cause, and streptomycin was 
not successful as the cure. 210 Finally, the Air Surgeon asked the School to test 
the Navy Quinn Water Purifier, which allegedly filtered bacteria from water. 
It was found that the bacteria were, in fact, removed but the apparatus soon 
left a harmful residue and was physically fatiguing to operate. 

Medical Aspects of Aircraft Accidents?* 1 A chance referral of the investi- 
gation of two crash deaths to the School's new pathology laboratory in October 
1942 led to the beginning of the pathological survey of accidents. This study 
was supported by the postulate that pilot, injury, physical force, and aircraft 
were all related in the common bond of accident. 212 By June 1943 the Research 
Division, Office of the Air Surgeon, was interested, 213 and several plans for re- 
gional medical study of aircraft accidents 214 culminated in the establishment of a 
Medical Division in the Office of Flying Safety. 215 

The study of accidents began in two ways — by case study, and by a general 
survey of all accidents, particularly those occurring at Randolph Field in 1942 
as a sampling. Two factors in these accidents seemed prominent — fatigue 
and unexplained spins or dives. 216 From Randolph the investigators went to 
Brooks Field in 1942. Many landing accidents at that base pointed to a possible 
revision of let-down procedures. Hass' chief ideological point was to ration- 
alize the term "pilot error" out of existence; he maintained that the pilot was 
the victim of an unprecedented combination of circumstances. 217 Another 
major cause of accident at that station seemed to be night flying, especially 
in view of loss of orientation by the pilot with respect to ground and neighbors 
in formation. Suitable recommendations were made, including revision of 
flight training. 218 Regarding the problem of repeated flying errors on the part 
of pilots, a system of periodic checks and follow-up was suggested. 219 

Exact causation of bodily injuries in aircraft accidents next occupied the 
attention of School pathologists. Force-time seemed to be an important 
factor. 220 Accidents involving personnel exposed to deceleration for brief periods 
of time were classified according to severity, injuries, and treatment described 
accordingly. 

The lesions described in the following paragraphs were encountered in 
the occupants principally of two-seated single and twin-engine training air- 
craft which crashed. 221 

Three principal reasons were advanced for the high incidence of cranial 
injury in personnel involved in aircraft accidents (the head was injured in 
80 to 90 percent of aircraft accidents) . First, responding to the forces of decelera- 



RESEARCH AND DEVELOPMENT 



331 



tion applied to the aircraft, the body tended to continue in the direction of 
motion until restrained by aircraft structure or safety devices. Second, the 
principal restraints, namely, the seat and seatbelt, served as an anchorage for the 
pelvis, permitting the head and chest to move as leading points for contact with 
cockpit structure. The use of the shoulder harness placed partial restraint upon 
this type of motion. Third, there were limitations of resistance of aircraft struc- 
ture to force, and structural collapse accentuated the dangers inherent in the 
tendency of the body to continue in the direction of motion. 

The principal parts of aircraft structure which made contact with the head 
were: 

1. The proximal margin of the frame of the anterior section of the canopy, 

2. The "cowling-instrument panel-cockpit" assembly. 

3. Structures along the lateral walls of the pilot compartment. 

4. The instrument panel. 

5. The shattered glass of canopy or windshield. 

When the canopy was open, or when Plexiglas was shattered with the 
canopy closed, the vertical portion was occasionally the source of severe cranio- 
facial lesions. This was especially true when the two principal components of 
force were such that the head moved forward and to one side or the other. The 
forces did not need to be great enough to produce any other bodily injury, 
especially when the occupant of the cockpit was leaning to one side to get a 
better view of the ground. 

The structure known as the "cowling-instrument panel-cockpit" assembly 
was the most serious source of injury to the head. The cowling formed the 
anterior and lateral margin of the cockpits of several types of training planes. 
It was rigid and well constructed. Its sharp margin was poorly shielded and 
it projected backward at a dangerous level. Motion of the head directly or 
obliquely forward during deceleration resulted in contact with this structure in 
many cases. The injuries varied from minor bruises of the face and forehead 
to partial decapitation. 

The instrument panel in some types of training planes was set well forward 
in the cockpits and was not demonstrated as a source of injury to the head in 
any case in which cockpit structure had remained reasonably intact and the 
safety belt tightly fastened. In most cases, the safety belts and seats held so 
that a safe margin of clearance was maintained unless forces were great and the 
aircraft had been demolished. The instrument panel, therefore, was not proved 
the sole source of severe injury in these types of training planes where there 
would have been any chance at all for survival. It was clear, however, that 

262297°— 55 23 



332 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



contact between the head and the panel was to be expected if the safety belt 
were fitted loosely or if there were collapse of structure. 

The instrument panel in other types of training aircraft was potentially 
a more serious source of injury. It was closer to the face of the pilot and was a 
point of contact in some cases where forces involved were relatively small 

Structures alongside the lateral walls of pilot compartments were numerous 
and need not be mentioned in detail, but they were, at times, responsible for 
injury not only to the head but also to other parts of the body. This had been 
particularly the case in one type of aircraft in which heavy metal bulkheads ran 
upward and medially on each side of the pilot compartment. These girders 
apparently served as important supports to the pilot compartment and wing 
assemblies but they were unshielded, sharp, and dangerous in a crash. 

The glass of the windshield, canopy, and pilot compartment was commonly 
shattered during contact deceleration. Lacerations of the face, neck, and arms 
were occasionally caused by flying particles of glass. Although fragments of 
glass had been found in wounds in several cases, they had caused no serious 
or fatal injuries. The greatest danger was to the eyes, but loss of an eye due 
to flying particles of glass has not yet been recorded. 

The head, especially the scalp and forehead, was occasionally injured when 
the aircraft nosed over at high velocity in such a way as to crush the top of the 
canopy. In general, however, the crash-bar, or protective turn-over assembly, 
had served a useful purpose and undoubtedly had prevented serious injury in 
these cases, even though in several instances the head of the pilot made a deep 
imprint in the ground. In only one known case had there been a fracture of 
the skull, secondary to contact between the vertex or occipital and aircraft 
structure or the ground during a noseover occurring at low velocity. 222 

A subsequent study of 75 post mortem examinations and 250 injured person- 
nel affirmed the partial truth of the old saying that personnel were either killed 
suddenly in an aircraft accident or were able to walk away from the wreckage. 
The "all or none" peculiarities of the action of large forces upon personnel 
strapped in seats when the forces were generally applied permitted a few state- 
ments, subject to modification by future experience. No person survived for 
more than a few seconds or minutes any of the following lesions: 

1. Compound fracture of mandible, parietal bone or occipital bone. 

2. Fracture of a vertebral body with significant signs of compression of the spinal cord. 

3. Fracture of sternum or one rib on each side of the thoracic wall. 

4. Fracture of more than three ribs on one side of the thoracic wall. 

5. Bilateral fracture of each clavicle, scapula or humerus. 

6. Bilateral fracture of each ischium or the midshaft of each femoral bone. 



RESEARCH AND DEVELOPMENT 



333 



7. Acute extensive closed subdural hematoma. 

8. Rupture of the wall of any chamber of the heart. 

9. Rupture of the thoracic aorta. 

10. Rupture of each lung with a bilateral complete pneumothorax. 

11. Extensive bilateral traumatic pneumonosis. 

12. Penetrating wound of the thoracic wall. 

13. Penetrating wound of the abdominal wall. 

14. Rupture of the liver, colon, or urinary bladder. 

In comparison with the preceding list of lesions which represented the apparent 
maximum limits of structural changes associated with no more than a brief 
survival, the following list represented experience with maximum survivable 
lesions: 

1. Compound fracture of frontal, nasal, zygomatic or maxillary bones. 

2. Fracture of vertebral bodies without significant signs or compression of the spinal 
cord. 

3. Unilateral fractures of clavicle, scapula, humerus, and three ribs. 

4. Bilateral fractures of transverse processes of lumbar vertebrae. 

5. Bilateral fractures of each ilium. 

6. Unilateral fracture of the femur. 

7. Bilateral fractures of tibia and fibula. 

8. Subarachnoid or intracerebral hemorrhage with or without cerebral laceration. 

9. Mediastinal emphysema. 

10. Multiple hemorrhages in the myocardium. 

11. Hemopericardium and hemothorax. 

12. Rupture of each lung with a partial bilateral pneumothorax. 

13. Extensive unilateral traumatic pneumonosis. 

14. Probable laceration of the diaphragm. 

15. Rupture of the spleen, kidney, adrenal or ileum. 

16. Laceration of mesentery of the ileum. 

17. Internal herniation of ileum through a traumatic mesenteric laceration with resultant 
gangrene. 

18. Hemoperitoneum and generalized peritonitis. 

Above all it was emphasized that none of these cases ever regained consciousness 
and then lapsed secondarily into unconsciousness or shock, unless there were 
important lesions in the thorax or abdomen. 

The high incidence of cranial injury in personnel involved in aircraft acci- 
dents and the fact that the majority of aircraft accident cases who had survived 
with cranial lesions had a "closed" type of lesion led to animal experimentation 
on this subject in 1945. A technique capable of producing continuity of the 
cranial vault was developed by application of a tool, cooled with a stream of 
carbon dioxide, to the surface of the skull. It was hoped to produce lesions 
which would closely resemble cerebral contusions and yield reproducible symp- 



334 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



tomatology so that experiments leading to a knowledge of the treatment of 
postcontusional complications could be made. It was also desired to learn 
the relationship between the magnitude of lesions and survival. 223 In the ani- 
mals used, extensive lesions caused death in eight to twenty-four hours. If no 
symptoms appeared in this period in the animal, no symptoms developed during 
the seven day observation period. 224 This work was not completed in Novem- 
ber 1945. The necessary experimental research on the action of force-time upon 
biological systems and aircraft structures was in process of accomplishment 
by the end of the war, or was definitely projected for the future. Steps were 
taken at the School, at Wright Field, and at the Naval Medical Research Insti- 
tute quantitatively to investigate these problems. 225 

The School also looked at the problem of human engineering, i. e., design 
of aircraft in view and avoidance of past accidents. In a study of 35 accidents 
involving such types as AT-6, BT-13, and BT-9, it was recommended that 
(1) a safety device be fitted into the plane as an equivalent of the shoulder 
harness, (2) "crash-bars" be incorporated in the design of all planes, (3) a 
shatter-proof substitute for plexiglass be devised for canopy and windshield, 
(4) metal portions of the cattopy he kept clear from the path of the head, (5) 
the lower and surrounding parts of the fire~wall be reinforced, (6) the floor 
of the cockpits be a separate assembly, (7) sharp edges and projections in the 
cockpit be eliminated, (8) the lower part of the instrument panel be rounded 
and guarded from the legs, (9) metal seats be redesigned to fit body contours 
and to have shock absorbers, (10) controls be designed so that when stick was 
pulled back, it would still be clear of the body, (11) instrument panel be well 
forward in the cockpit, (12) cowling of the instrument panel be redesigned 
to eliminate danger, (13) and a mechanical seat ejection be devised. 199 The 
Postwar Planning Board adopted all these recommendations, except the first 
and last which were subjected to further scrutiny. 226 

In a study of cases involving spin or dive crashes, these were found to be 
the reasons for failure to use parachutes: 227 

r. Unknown. 

2. Loss of control of the aircraft at too low an altitude to effect a recovery or to 
abandon the aircraft successfully. 

3. Lack of experience or instruction in method of abandoning the aircraft, critical 
emergency use of the parachute, and/or recognition of conditions which require the air- 
craft to be abandoned. 

4. Division of responsibility between pilots who are alternately flying aircraft. 

5. Passage of precious time as occupants successively leave the ship before the pilot 
makes his escape. 



RESEARCH AND DEVELOPMENT 



335 



6. Limitation of speed and accuracy of physiologic reactions such as: slow perception 
or reaction to stimulus of orientation, or vertigo. 

7. Inadequate psychologic reactions to emergency conditions such as fear or over- 
confidence. 

8. Unusual attitudes assumed by the aircraft after loss of control. 

9. Restraints imposed by force and velocity on occupants or control surfaces. 

10. Improper spatial relations between occupants and avenues or facilities of escape. 

11. Organic disease of occupants: nontraumatic disease or traumatic disease due to 
collision between aircraft in flight, structural failures in flight, or fire and explosion in flight. 

12. Inadequate spatial relations between the aircraft and the occupant or his opening 
parachute after the occupant has jumped from the aircraft. 

As a result of this study, the following recommendations were offered: 228 

1. Flying personnel should be instructed to orient their bodies in a direction perpendic- 
ular to the direction of force during attempts to escape from spinning aircraft whenever 
the assumption of such an attitude would seem advantageous. 

2. Efforts should be made to gain further information concerning the common direc- 
tion and magnitudes of forces developed in cases of the type described in this report. 

3. Advantage should be taken of a proper analysis of these forces in planning of the 
most effective device by which occupants may be mechanically ejected from spinning falling 
aircraft. 

Supplementary to previous design recommendations, the Subcommittee on 
Injury Hazards, Committee of Aviation Medicine, National Research Council, 
offered the following suggestions in June 1944, in a conference at Wright 
Field: 229 

1. The value of accurate descriptions of forces, damage to aircraft and injuries to per- 
sonnel is very great. Every effort should be made to extend these studies. Where descrip- 
tions cannot cover the subject adequately, photographs taken particularly with the intent 
of recording damage to the cockpit and parts of the assembly responsible for injuries should 
be of the first importance. 

2. The safety release should release the entire sliding hood rather than just one panel 
of the hood. 

3. The longerons, especially alongside the cockpits, should be strengthened to aid in the 
resistance of fuselage structure to anteroposterior and vertical forces. 

4. The integral unit of shoulder harness, seat belt, seat and structures to which these 
parts are fastened should be designed to resist much higher forces than they are capable 
of resisting at present. It is believed that the parts and attachments should remain intact 
under force of 50 G's applied anteroposteriorly or vertically for a period of time approaching 
one-half second. 

5. The control column which projects directly backward toward the chest is a serious 
hazard. A control stick with wheel or a similar device which moves forward with the point 
of fixation at the floor of the cockpit is recommended. 

6. The transverse horizontal bar from which rudder pedals in certain aircraft are 
suspended should be eliminated. Suspension laterally with retention of a lateral arm for 
each pedal should be entirely adequate. 



336 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

7. It is believed that in a crash a helmet is not a practical or proper solution to the 
problems of injury. 

8. Mechanical ejection of the occupants from the aircraft with an automatic device for 
opening the parachute. 

9. Integrated design of an entire cockpit asembly built as a unit and strongly reinforced. 
This assembly will then be set in the fuselage and mounted on shock absorbers that permit 
the entire assembly to move six to twelve inches under forces of 25 to 100 G's for periods 
approaching one-half second. 

The School of Aviation Medicine, in analyzing fatal aircraft accidents 
during flying training, concluded that an ejection seat and improvement of the 
parachute would be of great aid in lessening accidents. 280 When the Chief, 
Medical Research Division, Office of the Air Surgeon, consulted the Flying 
Safety Branch, AC/AS-3, Hq, AAF, and the Aero Medical Laboratory for their 
opinions regarding ejection seats, all agreed with the theory, and stated that 
research and development in this field should continue. 231 

Because case studies of aircraft accidents necessarily produced a posteriori 
and empirical conclusions, the School decided to create accidents, involving the 
study of G and internal injury, and to compare injury so produced with injuries 
encountered after actual accidents. The first of these experiments 232 was 
conducted by using a guillotine-like apparatus, surmounted by a platform 
on which mice were placed in a supine position, with the entire operation re- 
corded by camera. Although this apparatus operated under 1276 G, and pro- 
duced internal injuries similar to actual aircraft accidents, the experiment led 
to no conclusions. A second set of experiments utilized rabbits mounted on a 
carriage and allowed to descend down a 52 0 track. 233 Recognizable injuries 
were produced, but little of lasting scientific value was obtained from this 
attempt. The third set of experiments made use of anesthetized cats retained 
in a carriage similar to an aircraft interior subjected to deceleration, all being pho- 
tographed by a high-speed motion-picture camera. It was found that sudden 
displacement of the abdominal organs occurred as a result of sudden decelera- 
tion, that the internal injuries were not the result of externally applied force 
per se, and that waves of pressure might cross the anterior abdominal wall of 
animals in the supine position when the decelerative force was applied to the 
dorsal aspect of the animal. 234 

A strain gauge accelerometer was constructed as a modification of the 
Wheatstone bridge to measure forces over 1000 G, have a duration of less than 
0.001 second. The effects of gravity were caught not only on this instrument, 
but also on a photographed oscilloscope and by impression in paraffin. These 
figures (highest G, duration of G, and average G) were checked mathematically 
and found to be correct. 



RESEARCH AND DEVELOPMENT 



337 



Cats employed as the subjects of these experiments were given sedation, 
embedded in Plaster of Paris in the deceleration carriage, which was then 
released. Surviving cats were observed and then sacrificed; all subjects were 
autopsied. Injuries were placed in four categories according to severity, and 
a composite score was computed, additively based on injuries to affected organs. 
The lungs, liver, and spleen appeared to be most affected by hemorrhage and 
lesion; indeed, the lungs looked as if they had gone through a genuine aircraft 
accident. Statistical results seemed to indicate that the most severe accidents 
were produced by a high peak of force for a brief duration. 

Next, twenty-one human aircraft crash cases were studied and patho- 
logically compared with results obtained in the animal experiments. Both 
human beings and cats frequently experienced cerebral hemorrhages, but, while 
human beings suffered depressed fractures of the skull and partial evisceration 
of the brain, the cats did not. Hemorrhages into the lung parenchyma as well 
as traumatic emphysema of the lungs were encountered. Humans suffered 
extensive injuries to the heart and vessels; the cats did not. Other injuries 
suffered by both groups were: displacement of intra-abdominal organs, super- 
ficial lacerations or rupture of the liver, hemorrhage and rupture of the walls 
of the gastro-intestinal tract, and laceration of the spleen. Humans alone 
suffered traumatic kidney lesions, and only the cats (in experiments using a 
webbed abdomen strap) suffered retroperitoneal hemorrhages. Fractures of 
the skull, ribs, and extremities were common in the human cases and rare among 
the experimental animals. Generally, injuries to the pilots were more spec- 
tacular because their aircraft were traveling at high velocity at the time of 
accident. 

Because flyers had sometimes died after abrupt deceleration, with few 
signs of external violence, and had manifested transient bradycardia and fre- 
quent extrasystoles, it was decided to subject thirty experimental cats to an 
electrocardiographic study of the effects of deceleration. 235 Some cats were 
subjected to vagotomy, and some to an injection of physostymine; among the 
former, there was acceleration of the heart rate, and, among the latter, a 
decrease. Again the T-rate of vagotomized animals was noticeably inverted, 
but the T-rate of hypodermized animals was only midly affected. Accordingly, 
transient bradycardia appeared in control animals or in most animals receiv- 
ing injections; tachycardia, in most animals subjected to vagotomy. 

Another set of experiments attempted to explore the physical character- 
istics of pressure within the abdominal cavity, to oppose pooling of blood within 
the splanchnic circulation in man in the erect position and during exposure 
of positive radial acceleration. 236 It was found that the pressure within the 



338 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

abdomen is predominantly a static pressure produced by the weight of the 
overlying abdominal organs. At the Aero Medical Laboratory at Wright 
Field, application of positive G and pressure readings established the fact that 
the height of the hydrostatic column of abdominal contents became progres- 
sively reduced as greater G was applied. It was also found that the G-suit pro- 
tected its wearer by retaining the heart and diaphragm at approximately their 
normal position. These results encouraged the concept that the abdomen and 
contents were like a paper bag filled with water, then subjected to decelera- 
tion; high-speed motion picture films confirmed this thinking. 

The next step in the sequence of these experiments was to determine 
changes of pressure of anesthetized cats during sudden deceleration, 237 through 
the use of a strain gauge, fitted with a Wheatstone bridge and oscilloscope. 
Although a satisfactory picture of these waves of pressure was obtained, there 
was no evidence that the pressure was directly the cause of internal injury. 
It was reasoned that, on abrupt deceleration in the supine position, the abdomi- 
nal contents are alternately compressed and decompressed, with a vigorous 
displacement toward the diaphragm and lower lobes of the lungs, the increased 
pressure being transmitted through the abdominal blood vessels and abdominal 
tissues to those of the thorax. To counteract the interplay and fall of blood 
pressure opposed by energy imparted by the heart, on abdominal distension, 
a canvas corset seemed a possible solution. 

Wound Ballistics, Although much experimental work had been done on 
the wounding effect of special projectiles at high velocities, little detailed infor- 
mation was available as to the wounding effects of the standard ammunition in 
use during World War II. The statement had often been made that modern 
machine gun and rifle bullets, because of their high velocity, caused extensive 
damage to tissues up to a considerable distance from their actual line of passage, 
giving the impression of a wound caused by an explosive projectile. While 
undoubtedly true, in some instances, this statement was usually unqualified and 
unsupported by specific data. For medical reasons, it was considered important 
to have detailed information by means of which the probable and possible dam- 
age resulting from a bullet wound in a given location could be estimated. 

Consequently, experiments were designed and firing tests conducted, dur- 
ing the winter of 1943-44, on the Wright Field Range with sheep used as 
experimental animals. They were anesthetized and suspended from a wooden 
beam by ropes tied to the forelegs and lower jaw. Single shots were fired at a 
range of approximately 50 yards, using .30 and .50 caliber machine guns and 
the AN M2 20 mm. cannon. A few .30 caliber rounds were fired from a rifle 



RESEARCH AND DEVELOPMENT 



339 



at a distance of 20 yards. In some experiments, bullets tumbled by passage 
through an obliquely placed wooden ammunition box or %-inch duraluminum 
plate, placed 3 feet in front of the animal. Post-mortem examinations were per- 
formed on all animals. Photographs were taken on the firing range and at 
post-mortem examinations. In some cases, X-rays were also taken post-mortem. 
The characteristics of the ammunition used were as follows: 



Ammunition 


Weight of pro- 
jectile (grains) 


Muzzle velocity 

(f/s) 


Muzzle energy 
(ft.-lbs.) 


.30 cal. (Ml) 


168.5 


2,600 


2,540 


.50cal 


718 


2,800 


12, 500 


AN M2 20mm. 


2,000 


2,830 


35,600 



It was concluded from this study that: 

1. Standard .30 (Mi) and .50 caliber bullets, fired at close range (50 yards) 
through the soft tissues of an animal produced small, clean wounds of entrance 
and exit and a channel of small diameter through the tissues. There was no 
"explosive" effect, or damage at any considerable distance from the line of 
passage. 

2. When a bone was hit by a .30 or .50 caliber bullet, it was extensively 
shattered, and a large, ragged soft-tissue wound was produced around and 
behind the bone. This type of wound was much more extensive than that made 
by a low velocity bullet under the same circumstances. 

3. When .30 and .50 caliber bullets were tumbled prior to striking an 
animal, enormous destructive wounds resulted. The contrast between these 
wounds and those made by untumbled bullets indicated that the latter expended 
only a small fraction of their energy in passing through the soft tissues of a large 
animal. 

4. Small fragments torn from the outer jacket of a .50 caliber armor-piercing 
bullet during its passage through an obstruction were easily capable of inflicting 
fatal wounds. These fragments flew at a considerable angle to the path of 
the bullet itself. 

Following these studies, experiments were carried out investigating the 
wounds made by a 90 mm. HE shell at close range to the burst and of the 
wounding mechanisms of high energy projectiles, such as the .50 caliber M2 
armor-piercing and ball ammunition. The latter experiments were carried out 



340 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

at the Proving Ground of the University of New Mexico under the supervision 
of the Department of Physics, which had been delegated by the OSRD. Dr. 
Milton Helpern, Deputy Chief Medical Examiner, City of New York, performed 
the pathological examinations. Conclusions reached as a result of these studies 
were: 

1. The size and shape of wounds made by high-energy projectiles and the 
special wound patterns which occur in different organs and body tissues can 
be understood through a combined knowledge of the general wounding mecha- 
nisms of projectiles and the special structure of the body regions involved. 

2. Such an understanding will assist the physician in making rapid, useful 
predictions as to the total extent of a wound and the special injuries which may 
have occurred from an inspection of its superficial aspects. 

3. A physician who understands the mechanism of wound formation and 
the properties of weapons in current use can make a general identification of 
the causative agent in the great majority of cases of individuals killed in action. 

Among the Heroes: Colonel Boynton 238 

The preceding survey of research activities, inadequate and brief though 
it may be, does nevertheless give some indication of the scope and extent of 
the investigations of the Aero Medical Laboratory and the School of Aviation 
Medicine, during the war period, into the nature and characteristics of modern 
flying and the requirements for human survival under its demanding and 
perilous conditions. These studies, running the gamut of high-altitude prob- 
lems, anthropometric researches necessary in designing equipment and modi- 
fying aircraft, to suit human somatic traits, investigations of the physiologic 
effects on the body of acceleration, and development of a preventive medicine 
regimen looking towards an optimum of physical fitness in the flyer, were 
motivated throughout by the stringent exigencies of modern warfare. They 
sought to increase the potential of military aircraft by reducing the hazards 
of high-altitude, high-speed flight. It is a tribute to human endeavors that, 
significant as these researches were for times of national peril, they bore, also, 
a residue of fruit for peace-time, commercial aviation and all the benefit that 
go with it. 

Nevertheless research in aviation medicine of the type described cannot 
be carried out without cost of human life. Individuals volunteering their 
services were heroes of the same caliber as those who willingly faced enemy 
bullets, and they lived daily with danger. Symbolic of those flight surgeons 
who willingly accepted the pattern of risk and sacrifice to the end that others 



RESEARCH AND DEVELOPMENT 



341 



might live were Lt. Col. William Randolph Lovelace, II (MC), Chief of the Aero 
Medical Laboratory at Wright Field, and Lt. Col. Melbourne W. Boynton 
(MC), Chief of the Medical Division, Office of Flying Safety. Colonel Lovelace 
lived to tell his story; Colonel Boynton did not. 

The problem of high-altitude jumps was a very major one to the AAF 
in 1943. In June of that year Colonel Lovelace jumped from a height of 
40,200 feet at Ephrata, Washington. This was the highest altitude jump ever 
attempted. He wore standard equipment and used standard equipment. 
When he landed, he was suffering from severe shock and with frost bitten 
hands and limbs. Out of this experiment was to come proof that the danger 
of shock from the opening of a parachute at an altitude in excess of 30,000 
feet was far greater than those made closer to the ground. 

Colonel Boynton, vitally interested in the problem of parachute landings, 
in August 1944 undertook what he considered to be a continuation of the Love- 
lace experimentation in high-altitude jump. Son of a Baptist minister and 
himself a missionary to Rangoon and later a practicing obstetrician at Lying-in 
Hospital in Chicago, he had accepted a Reserve commission and entered the 
Service in April 1941. He completed the flight surgeon's course and also the 
parachute course at Fort Benning. Earlier experiments in which he partici- 
pated had included both sea survival and altitude jumping. He had been one 
of the nine volunteers who went without food and water for ninety-six hours 
in a life raft in the Gulf of Mexico. At the U. S. Forest Service Parachute 
Training Center at Seely Lake, Montana, he made parachute jumps over the 
rocky hillsides and over the treed terrain; he had likewise made parachute 
jumps over the Gulf of Mexico. Thus, more than any other officer, he was 
particularly equipped, it would seem, to carry out the experimentation begun 
by Colonel Lovelace. 

On the Saturday afternoon of 19 August 1944 he prepared to make a jump 
at 43,000 feet with a free fall wherein he would open his parachute at 5,000 
feet. He wore standard clothing and equipment. His jump was calculated 
to establish the characteristics of free fall and to determine the rate of decelera- 
tion and the path of fall. He hoped to develop procedures for aircrews bailing 
out at high altitudes. 

At 1313 he dropped through the bomb bay of a Flying Fortress which 
had taken off from the Clinton County Air Base near Wilmington, Ohio. 
Nearly a hundred spectators from nearby Wright Field watched him. Two 
minutes and fifteen seconds later he landed in a cornfield at the edge of the 
airbase. His parachute had failed to open. What had transpired in his 
eight-mile fall could never be known. It was found that his equipment was 




Lt. Col. Melbourne W. Boynton (MC). 



RESEARCH AND DEVELOPMENT 



343 



in satisfactory condition and that he had made no apparent attempt to open 
either of his parachutes. It would appear therefore that the accident was 
caused by some condition which caused human failure. Since Colonel Boynton 
had been both control officer and subject, the answer could not be known. 
This experience did, however, demonstrate the scientific requirement that 
the subject not control the experiment. 

NOTES TO CHAPTER IV 

*H. G. Armstrong, Principles and Practice of Aviation Medicine, Baltimore: Williams & Wilkins, Co., 
1952, P. 47- 

2 Malcolm C. Grow, "Establishing the USAF Medical Service" in USAF Medical Service Digest, IV 
(Jul 53) >P. 2. 

3 Interviews with General Grow by M. M. Link, 5 Jun 52. 
x lbid. 

6 Ibid. 

8 Hist, of Organ, and Admin. AAF Med. Serv. in the ZI, Vol. I, p. 284. Pages 272-360 are devoted 
to the AML and the following paragraphs unless otherwise specified, are based upon this source. 

7 As of late September 1941 the staff of the laboratory consisting of the following specialists: 



Dr. F. G. Hall Duke University — aerombolism and acid base balance. 

Dr. G. Millikan Cornell Unversity — design of oximeter and of oxygen equipment. 

Dr. A. P. Gagge Yale University — evaluation of oxygen requirement in flight personnel. 

Dr. E. J. Baldes Mayo Clinic — acceleration (centrifuge) design. 

Dr. S. Robinson Indiana University — physiological effects of cold. 

Dr. E. Turrell Indiana University — physiological effects of cold. 

Dr. K. Penrod Miami University — evaluation of oxygen equipment. 

Mr. S. Harvoth Harvard University — anoxia and oxygen equipment. 

Dr. F. A. Hartman Ohio State University — fatigue and adrenal cortical hormones. 



8 Armstrong, op. cit. p. 48. 

9 Prepared by staff, Aero Medical Laboratory as part of official AAF medical history. Material in this 
section, except for minor editorial changes and additions, appeared in periodical form. See A. Damon and 
Frances E. Randall, "Physical Anthropology in the AAF," American Journal of Physical Anthropology II 
(Sep 44), pp. 293-315. 

10 Nasion-menton length: distance from the tip of the chin to a point in the depression of the root 
of the nose. This is the anthropological face-height; that part of the forehead between the hairline and the 
eyebrows is anatomically a part of the skull cap (frontal bone) and does not belong to the face structure. 

11 Requirements for Gunner's Provisions in Local-Control Turrets, Technical Note TN-49-2, Arma- 
ment Lab. Engr. Div., ATC, Wright Fid, Ohio, 8 Jan 44. 

32 Francis E. Randall, A. Damon, Robert S. Benton, and Donald I. Pat, Human Body Size in Military 
Aircraft and Personal Equipment, AAF Tech. Rpt. No. 5501, AML, Engr. Div., ATSC, Wright Fid, Ohio, 
10 Jun 46. 

13 L. D. Carlson, Application of Basic Physiological Data in the Design of AAF Oxygen Equipment, 
AML. Engr., Div., ATSC, Wright Fid, Ohio, 9 Nov 45. 

14 L. D. Carlson, "A Concise Description of the Demand Oxygen System," The Air Surgeon's Bulletin, 
I (Jan 44), 14. 

U H. M. Sweeney, "Explosive Decompression," The Air Surgeon's Bulletin, I (Oct 44), 1. 
18 Conventional quantitative terms used by aeronautical engineers. 

37 A. P. Gagge, Explosive Decompression — A Summary and Evaluation for Aircraft Designers, Memo. 
Rpt. No. TSEAL 3-695-29M, AML, Engr. Div., ATSC, Wright Fid, Ohio, 2 Jul 45. 



344 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



M George A. Hallenbeck, Design and Use of Anti-g Suits and Their Activating Values in World War U, 
AAF Tech Rpt. No. 5433, AML, Engr., Div., ATSC, Wright Fid, Ohio, 6 Mar 46. 

10 W. R. Lovelace, Development of Webbing Strap Litter Support Installation for Cargo Aircrajt. 
Memo Rpt, No. TSEAL-3-697-2JJJ, AML, Engr., Div., ATSC, Wright Fid, Ohio, 20 Sept 45. 

20 This section is based on L. L. Sloan, et al., "Research in Ophthalmology," Rpt. No. 5, Professional 
History. 

21 Richard G. Scobee, An analysis of the Ophthalmic Portion of the "64" Examination: Muscle Balance. 
AAFSAM Project No. 139-1, 1 Aug 45. 

"Ibid. 
"Ibid. 

24 R. G. Scobee, E. L. Green, and H. L. Moss, A Comparison of Tests for Heterophoria: Variations in 
the Screen -Maddox Rod Test Due to Ocular Dominance, Rod Color, and Screening, AAFSAM Project No. 
375-4, 20 Jul 45. 

"Ibid. 

28 R. G. Scobee, Progress Report on Visual Acuity Studies, Aug 45- 

27 "Monthly Memo. Research Rpt.," 1 Aug 45. 

28 William M. Rowland and Louise Sloan Rowland, A Comparison of Three Tests of Depth Perception, 
AAFSAM Project No. 238-1, 14 Mar 44. 

w Minutes and proceedings of the Army-Navy-OSRD Vision Committee, nth meeting. Wash., D. C, 
Apr 45- 

80 AR 40-1 10, Hq WD, Wash., D. C, 3 Dec 42. 

"Louise Sloan Rowland and Pfc. Frederick V. Heagan, Frequency of Color Deficiency Among Air 
Corps Cadets, AAFSAM Project No. 31 4-1, 31 Aug 44. 

32 Ltr., TAS, Hq AAF, Wash., D. C, to Comdt. AAFSAM, 6 Jan 43. 

88 L. S. Rowland, A Simple Anomaloscope for Detecting and Classifying Red-Green Color Deficiencies, 
AAFSAM Project No. 137-1, 29 Jul 43. 

5,4 L. S. Rowland, Intensity as a Factor in Recognition of Light Signals, AAFSAM, Projects Nos. 37-1, 
21 Aug 42 and 97-1, 1 Jan 43. 

Sfl L. S. Rowland, Selection and Validation of Tests for Color Vision: The Color Threshold Lantern as 
a Quantitative Test for Red -Green Color Deficiencies, AAFSAM Project 137-5, 20 Oct 43. 

" L. S. Rowland, Selection of Battery of Color Vision Tests, AAFSAM Project No. 108-1, 19 Feb 43. 

87 Med. Hist, of World War II, AAFCFTC, vol. 3, 1940-44, P- 95- 

88 "Conference on Night Vision," 14 Dec 43. 

w Philip R. McDonald, The Reliability of the AAF Night-Vision Tester, AAFSAM Project No. 199-1. 
10 Nov 43. 2. Wm. M. Rowland and Joseph Mandelbaum, A Comparison of Night-Vision Testers, 
AAFSAM Project No. 21 3-1, 22 Jan 44. 

40 AFR 25-2, Hq, AAF, Wash., D. C, 12 Oct 44. 

41 W. M. Rowland, A Study of Methods of Gun Sighting at Extremely Low Levels of Illumination, 
AAFSAM Project No. 82-1, 23 Sept 42. 

"Richard G. Scobee, The Efficacy of Penicillin in Uveitis Therapy, AAFSAM Project No. 250-1, 
9 May 44. 

48 Paul A. Campbell, Aircraft Obscuration by Sun Glare, AAFSAM Project No. 34-1, 7 Apr 42. 

** Francis C. Keil, The Effect of Oral Doses of Hyascine on Visual Efficacy, AAFSAM Project No. 1, 
2 Jun 43. 2. Richard G. Scobee, Possible Effects of Small Daily Doses of Sulfadiazine on Flying Personnel, 
AAFSAM Project No. 293-1, Part 8, 29 Jul 44. 

48 This section is based on Col. P. A. Campbell, et al., "Research in Otolaryngology," Rpt. No. 23, 
Professional History. 

49 H. G. Armstrong, op cit., p. 255. 

41 C. M. Kos, "Effect of Barometric Pressure Changes on Hearing," Arch Otolaryng. XLI (May 45). 
322-326. 

48 P; A. Campbell and J. Hargreaves, "Aviation Deafness — Acute and Chronic," Arch. Otolaryng. XXXII 
(May 1940), 417. 



RESEARCH AND DEVELOPMENT 



345 



49 P. A. Campbell, "The Effect of Flight Upon Hearing," /. Avn. Med., XIII (Jan 42), 56. 

60 J. F. Simpson, "General Survey of Otorhinological Consideration in Service Aviation," f. Laryng. & 
Otol. LVII (Jan 42), 1-7. 

Bl B. H. Senturia, Determination of Auditory Acuity Following Various Periods of Exposure in the 
Altitude Chamber, AAFSAM Project No. 129, 19 Mar 43. 

53 F. W. Ogden, A Study of Altitude Chamber Aero-Otitis Media, AAFSAM Project No. 147, 5 May 43. 

53 F. W. Ogden, The Study of Effects of Vasoconstrictor Solutions on Altitude Chamber Aero-Otitis 
Media, Project No. 159, 1 Jun 43. 

84 See n. 52. 

"F. W. Ogden, "Politzerization: A Simple and Effective Method in Treatment of Aero-Otitis Media," 
Air Surgeon Bulletin, I (Apr 44), 18. 

68 C. M. Kos, "Radium applied to Nasopharynx," AAFSAM Monthly Memo. Research Rpts. 1 Mar 45. 

W B. H. Senturia, and H. B. Peugnet, "Aero-Otitis Externia," Air Surgeon's Bulletin, II (Apr 45), 108. 

38 P. A. Campbell, "Aerosinusitis — Cause, Course and Treatment," Ann. Otol., Hhin. & Laryng., LII 
(1944), 291, 301. 

59 R. W. Wright, and R. E. Boyd, "Aerosinusitis," Arch. Otolaryng., XLI (i945)> P- 193- 

60 P. A. Campbell, "Aerosinusitis— A Resume," Ann. Otol, Rhinol. & Laryng., LIV (Jan 45), 69-83. 

61 Seen. 58. 

92 B. H. Senturia, Etiology of External Otitis, AAFSAM Project 349, 15 Jan 45. 

W B. H. Senturia, Penicillin Therapy in External Otitis, AAFSAM Project No. 247, 29 Mar 45. 

64 B. H. Senturia, A Survey of Auditory Acuity Among Pilots and Enlisted Trainees, AAFSAM Project 
171, 14 Sept 43; Auditory Acuity of Aviation Cadets, AAFSAM Project 239, 3 May 42. 

65 H. B. Peugnet, Measurements of Noise in Aircraft, AAFSAM Project No. 296, Feb 45. 

"This section is based on D. F. Mitchell, "A History of Aviation Dentistry with emphasis on Develop- 
ment in the AAF during World War II," Professional History. This history includes discussions of 
existing knowledge in the field of dentistry including foreign studies since the School utilized and synthesized 
whatever data were available. 

6T W. C. Fischer, "The Advisability of Recording the Models of Jaws of Aviators," Assoc. Mil. Dent. 
Surg. U. S. A., II (1918)* 169. 

08 Aviation Dentistry, First Conference; A Summary of Proceedings, Chicago, 111., Feb 45. 

89 Mitchell, op. cit., pp. 1-22. 

T0 Anon, "Foreign Letter, London," Journal of American Medical Association, CXVII (1940), 11 10. 

71 T. V. Joseph, C. F. Gell, R. M. Carr and M. C. Shelesnyak, "Toothache and the Aviator," U. S. 
Nav. Med. Bull., XLI (May 1943), 643. 

72 D. F. Mitchell, "Aerodontalgia," Bull. U. S. Army Med. Dept., LXXIII (Feb 1944), 62. 

78 1. W. Brickman, "Toothache in Low Pressure Chamber," U. S. Nav. Med. Bull, XL1I (Aug 1944). 
292; 2. Keith DeVoe, and H. L. Motley, "Aerodontalgia," Den. Dig., LI (Jan 1945), 16. 

74 W. Freitag, "Uber die Einwirkung der Kalte auf das Zahnsystem," Luftfahrtmedizin, VII (1943), 

335- 

"Warren Harvey, "Tooth Temperature with Reference to Dental Pain While Flying," Brit. Dent. ]., 
LXXV (Nov 1943), 221. 

Te W. Freitag, "Die Vernanderugen Des Luftdruckes und ihr Einflues auf das Zahnsystem des 
Menschen," Luftfahrtmedizin, LX (1944), 49. 

17 R. F. Sognnaes, "Studies on Aviation Dentistry," Distributed by Comm. on Avn. Med. Research of 
NRC of Canada, May 44. 

"Warren Harvey, "Some Aspects of Dentistry in Relation to Aviation," Den Rec. LXIV (Sept 1944), 

199. 

"Leonard Weiner, and E. C. Horn, "Etiology of Aerodontalgia," Air Surgeon's Bulletin, 11 (May 
1945), 156. 

80 R. H. Kennon and C. M. Osborn, "A Dental Problem Concerning Flying Personnel," f. Amor. Den. 
Assoc., XXXI (May 1944), 662. 

81 H. C. Sandler, "Toothache at Low Atmospheric Pressures," Mil. Surg., XCVH (Dec 1945), 475- 



346 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



83 B. Orban and R. Ritchey, "Toothache under Conditions Simulating High Altitude Flight," /. Amer. 
Den. Assoc., XXXII (Feb 1945), 145-180. 

83 Ibid. 
M 1bid. 

85 Mitchell, op. ext., p. 252. 

M Glenn Willhelmy, "Relationship of Overclosure of the Mandible to Ear Pains While Flying," Den. 
Dig., XL VII (Dec 1941), 544; "Aviation Splints," in E. J. Ryan, and H, E. Davis, ed., Lectures on War 
Medicine and Surgery for Dentists, Chicago Dental Society (1943), 141. 

"I. W. r3rickman, and H. R. Bierman, Relationship to Dental Malocclusion to Ear Block, in the Low 
Pressure Chamber, A Rpt from the Dental Dept and Physiological Research Sect., U. S. Naval Air Training 
Center, Pensacola, Fla., 1943. 

88 See n. 78. 

89 J. R. Restarski, "Effect of Changes in Barometric Pressure upon Dental Fillings," U. S. Nav. Med. 
Bull., XLII (Jan 1944) , 155. 

90 Glenn Willhelmy, "Aerodontalgia," Den Dig., XLIX (Jul 43), 311. 

91 1. Gersh and J. S. Restarski, "The Effects of Simulated Altitudes Upon the Incisor of the Rat." 
Anatomical Rec, XC (Nov 1944), 191. 

92 J. S. Restarski, "Effect of Vibration upon the Dental Pulp and Periosteum of White Rats," /. Den. Res., 
XXIV (Apr 1945), 57- 

93 See n. 77. 

84 F. C. Snyder, H. D. Kinball, W. B. Bunch, and J. H. Beaton, "Effects of Reduced Atmospheric 
Pressure upon Retention of Dentures," /. Amer. Den. Assoc., XXXII (Apr 1945), 445. 

95 J. C. Specker, "Dentures and Oxygen Mask," Air Surgeon's Bulletin, I (Aug 1944), 21. 

96 W. W. Senn, "Incidence of Dental Caries Among Aviation Cadets," Mil Surg., XCHI (1943), 461. 

97 D. F. Mitchell, Effects of Oxygen and Decompression on Saliva, Project No. 392, Report No. I, 
AAFSAM, 1 1 Jun 45. 

98 Dwight S. Coons, "Aeronautical Dentistry," /. Canada Den. Assoc., IX (Jul 43), 320. 
99 A. A. Goldhursh, "Dental Survey of Fighter Pilots," II (Dec 1945), 436. 

^"Aviation Dentistry, Second Conference, A Summary of Proceedings," Randolph Fid, Tex., Nov 45. 
301 This section is based on A. Hemingway, and P. K. Smith, "Air Sickness in AAF," Rpt. No. 13, 
Professional History. 

™' z Nevertheless, Hemingway and Smith (op. cit., p. 1050) conceded that "There are . . . cases of 
air sickness in combat" and more information on the problem of air sickness in combat is needed. 
103 Hemingway and Smith, op. cit., pp. 1049-1055. 

w D. D. Bond, A Psychiatric Analysis -of Forty (40) Subjects Made Sick by a Swing, AAFSAM Project 
No. 149, 3 1 Jul 43. 

105 Allan Hemingway, An Apparatus for Measuring the Onset of Sweating During the Development of 
Motion Sickness, AAFSAM Project No. 92, 5 Nov 42. 

108 Allan Hemingway, The Effect of Environmental Temperature on Motion Sickness, AAFSAM Project 
No. 170-3, 2 Nov 43. 

307 Allan Hemingway, Results on 500 Swing Tests for Investigating Motion Sickness, AAFSAM Project 
No. 31-2, 5 Nov 42. 

198 Allan Hemingway, Incidence of Swing Sickness in Eight Categories of Army Personnel. AAFSAM 
Project No. 170, 30 Jul 43. 

109 Allan Hemingway, Incidence of Airsickness in Cadets During Their First Ten Flights. AAFSAM 
Project No. 170-5, Jan 45. 

110 H. J. Rubin, "Air Sickness in a Primary Air Force Training Detachment," /. Avn. Med., XIII (Dec 
1942), 226-272. 

111 D. M. Green, "Air Sickness in Bomber Crews," /. Avn. Med., XIV (Dec 1943), 366, 372. 

112 F. E. McDonough, Air Sickness During an Airborne Infantry Maneuver, AAFSAM Project No. 93-1, 
16 Nov 42; Air Sickness in Airborne Infantry. AAFSAM Project No. 93-2, 27 Nov 42. 

113 First used in Russia in 1926. A. K. Mclntyre, Motion Sickness: Present Status of Research, RCAF 
Flying Personnel Research Committee, Jun 44. 



RESEARCH AND DEVELOPMENT 



347 



114 Allan Hemingway, Adaptation to Flying Motion by Air Sick Aviation Students. AAFSAM Project 
No. 170-4, Dec 43. 

115 See n. 104. 

116 See n. 109. 

UT 1. P. K. Smith and Allan Hemingway, Effect of Barbital on Swing Sickness, AAFSAM Project No. 
104, 9 Jan 43; 2. P. K. Smith and Allan Hemingway, Effect of Vasano on Swing Sickness, AAFSAM 
Project No. no, 2 Mar 43; 3. P. K. Smith, Effect of Benzedrine on Swing Sickness, AAFSAM Project No. 
113, 9 Aug 43; 4. P. K. Smith, Effect of V-$ on Swing Sickness, AAFSAM Project No. 132, 8 Apr 43; 
5. P. K. Smith and Allan Hemingway, Effect of Thiamine Chloride on Swing Sickness, AAFSAM Project 
No. 142, 10 Aug 43; 6. P. K. Smith, Effect of Pyridoxine Hydrochloride on Swing Sickness, AAFSAM 
Project No. 333-2, 24 Aug 45. 

118 /. P. K. Smith and Allan Hemingway, Effect of Hyoscine (Scopolamine) in Swing Sickness, 
AAFSAM Project No. 111,2 Mar 43; 2. P. K. Smith and Allan Hemingway, Effect of Hyoscine on Swing 
Sickness, AAFSAM Project No. n 1-2, 19 Apr 43. 

11& P. K. Smith and Allan Hemingway, Effect of U. S. Army Development Type Motion Sickness 
Preventive on Swing Sickness, AAFSAM Project No. 198, 8 Nov 43. 

120 P. K. Smith, Effectiveness of Some Motion Sickness Remedies in Preventing Air Sickness, AAFSAM 
Project No. 261, Rpt. No. 2, 18 Jan 45. 

m P. K. Smith, Present Status of Drugs for Use in Motion Sickness with Particular Reference to Air 
Sickness, AAFSAM Project No. 468, Mar 46. 

122 This section is based on R. C. Anderson, et al., Research in Neuropsychiatry," Rpt. No. 14, 
Professional History. 

123 Ibid., p. 1 1 27. 

m Melvin W. Thorner, Correlation of Electroencephalograph^ Patterns with Flying Ability with 
Special Reference to the Basic States of Flying Training, AAFSAM Project No. 1, 2 Feb 42. 

125 1. M. W. Thorner, Procurement of Electroencephalographs Tracing on 1,000 Flying Cadets for 
Evaluating the Gibbs' Technique in Relation to Flying Ability, AAFSAM Project No. 7, 21 Sept 42; 2. 
Rosemary E. Schroeder, Predictions of Flying Ability for the EEG by the RCAF, AAFSAM Project No. 85, 
24 Oct 42; 3. M. W. Thorner, Davis' Analysis of Relation of EEG to Flying, AAFSAM Project No. 94, 
18 Dec 42. 

128 M. W. Thorner, Automatic Reaction* to Startle: Photoelectric Plethysmo graph, AAFSAM Project 
No. 135, 25 Nov 43. 

127 W. H. Sheldon, A Basic Classification Applied to Aviation Cadets, AAFSAM Project No. 135, 25 
Nov 43. 

138 Memo, for Comdt., AAFSAM, from C/Psych. Dept., AAFSAM, 7 Mar 44. 

129 Herman M. Turk, A Single Coordination Test Used in the Selection of Aviation Cadets, AAFSAM 
Project No. 196, 16 Nov 43. 

130 Interview, Capt. W. D. O'Gorman, C/Neuropsychiatry Sec, Base Hosp., AAB, Harding Fid, La., 
by Hist. Off., AAFSAM, 12 Feb 46. 

131 Capt. W. D. O'Gorman, C/Neuropsychiatry Sec, Base Hosp., AAB, Harding Fid., "The Psychologi- 
cal Evaluation of Combat Pilots by Means of the Minn. Multiphasic Personality Inventory," a study sub- 
mitted to the Surg., II AF, Colorado Springs, Colo., Nov 43. 

™ Interview, Capt. W. D. O'Gorman, C/Dept. of Neuropsychiatry, AAFSAM, by Hist. Off., AAFSAM, 
5 Mar 46. 

133 M. W. Thorner, A Proposed Revision of the Neuropsychiatry Standards of AR 40-110; Muscle 
Atrophy, AAFSAM Project No. 150, 16 Sept 43. 

334 H. M. Turk, Relation of Broken Homes to Success in Flying Training, AAFSAM Research Project 
No. 203-1, 17 Nov 43. 

136 M. W. Thorner, EEG in Aviation Cadets Giving in History of Fainting, AAFSAM Project No. 75,. 
22 Aug 42. 

UB M. W. Thorner, A Study of Enuresis in Aviation Cadet Applicants, AAFSAM Project No. 134, 24 
May 43. 

137 Rpt, C/Dept. of Neuropsychiatry, SAM, to Comdt., 31 May 44. 

138 Ltr., TAS, Hq, AAF, to CG, III AF, Tampa, Fla., 1 Jan 45. 

262297°— 55 24 



348 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



230 2d Ind. (basic ltr., C/Dept. of Neuropsychiatry, AAFSAM to Comdt., AAFSAM, 7 Jul 44), Deputy- 
Air Surg., Hq, AAF, Wash., D. C, to Comdt., AAFSAM, 28 Sept 44. 

140 Ltr., Sp. Asst., to TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 12 Jun 45; Ltr., Comdt., 
AAFSAM, to CG, AAF, Off. of TAS, 2 Apr 45. 

141 M. W. Thorner, A Study of Cerebral Physiology at High Altitudes, AAFSAM Project No. 60, 1 Mar 
43; A Study of Cerebral Physiology at High Altitudes , AAFSAM Project No. 60-2, 15 Jan 44. 

142 A. H. Hill, P. K. Smith, The Influence on Cortical Activity of Large Doses of Atabrine Dihydro- 
chloride, AAFSAM Projects No. 232, 27 May 44> and 363-^ 5 May 45. 

143 Annual Rpt, I945> P- 40. 

144 D. D. Bond, Psycho pathologic Reactions to Aircraft Accidents, AAFSAM Project No. 183, 20 Sept 43. 
148 This section is based on A. W. Melton, "The Psychomotor Test Research Program," Rpt No. 10, 

Professional History. 

14 *OC/AC, to CG, GCACTC, Randolph Fid, Tex., 27 Nov 41. 

147 Ltr., Comdt. SAM to AFTAS, Wash., D. C, 28 May 42. 

148 Ltr., TAS to Comdt., SAM, 23 Mar 42. 
140 Ibid. 

" Ltrs. Comdt., SAM, to CG, AAF, 18 Mar 43; AFTAS to Comdt., SAM, 4 May 43. 
"* See n. 147. 

3d Ind. (Ltr., Comdt., SAM, to AFTAS, 10 May 43), AFTAS to Comdt., SAM, 1 1 Jun 43. 
™ /. AAFSAM Project No. 275-1, 12 Jul 44; 2. Annual Rpt, AAFSAM, FY 1945, par. 34. 
1M Annual Rpt, AAFSAM, 1944, p. 8. 

156 Ltr., CG, AAF, to Comdt, SAM, 13 Nov 44; 2. 1st Ind. (Ltr., Comdt., SAM to AFTAS, 16 Apr 45) 
CG, AAF, to Comdt., SAM, 24 Apr 45; 3. Annual Rpt, AAFSAM, 1944 and 1945- 
™ Annual Rpt, AAFSAM, FY, 1945. 

"* AAFSAM Projects No. 98-1, 9 Dec 42 and 21 4-1, 1 1 Dec 43; 2. Annual Rpt, AAFSAM, FY 1945. 
AAFSAM Project No. 340-1, 24 Aug 44; 2. Annual Rpt, AAFSAM, FY 1945- 

169 AAFSAM Proect No. 416-1, 5 Sept 45. 

100 AAFSAM Project No. 44-1, 6 Oct 42; 2. Project No. 274-1, 30 Aug 44; 3. Annual Rpt, AAFSAM. 
FY 1945. 

181 AAFSAM Project No. 78-1, 15 Nov 45; 2. Annual Rpt, AAFSAM, FY 1944; 3- Annual Rpt. 
AAFSAM, FY 1945. 
162 See n. 156. 
™lbid. 
184 Ibid. 
™lbid. 

186 R. H. Broh-Kahn, W. D. Barcus, and R. B. Mitchell, The Use of Polyvalent Serum for the Rapid 
Identification of Salmonella Cultures, AAFSAM Project No. 473, 30 Apr 46. 

1BJ W. D. Barcus, R. H. Mitchell, and R. H. Broh-Kahn, Abstract of "The Use of Polyvalent Serum for 
the Rapid Presumptive Identification of Salmonella Cultures," for publication in J. Bacter. and presented to 
the Society of American Bacteriologists, Detroit, Mich., 22 May 46. 

188 A. F. Coburn, "The Control of Streptococcus Hemolyticus," Mil. Surg., CXVI (Jan 45), 17-40. 

199 R. H. Broh-Kahn, and G. L. Erdman, "Sulfapyrazine — Its Use in Prophylaxis of Respiratory Disease, 
Am. ]. Mil. Science, CCXII (Aug 1946), 170-178. 

170 B. H. Senturia and R. H. Broh-Kahn, Use of Streptomycin in the Treatment of Diffuse External 
Otitis, AAFSAM Project 486-1, 1 Feb 47. 

1J1 This section is based on Capt. I.E. Williams, "Studies Relative to the General Medical Section of 
the Physical Examination for Flying." Rpt No. 17, Professional History. The author stated that this report 
did not include previously discussed matter on ophthalmology, otolarynglogy, neuropsychiatry, and psycho- 
motor tests. 

172 Herman M. Turk, Relation of the Schneider Index to success in Flying Training, AAFSAM Project 
No. 190, 19 Oct 43. 

173 AR No. 40-1 10, Sec. Ill, par. 20, Wash., D. C, 12 Dec 44. 

174 Charles E. Kossman, Some Observations on Blood Pressure Relative to the Examination for Flying, 
AAFSAM Project No. 264, 31 Mar 45. 



RESEARCH AND DEVELOPMENT 



349 



""Isabel R. Berman, The Reliability of Heights, Weight, Chest and Obdominal Measurements of 
Aviation Cadets, AAFSAM Project No. 18, 2 Jul 42. 

176 A. B. Schneider, Jr., Problems of Selection in Medicine — Airline Director's Conference, AAFSAM 
Research Files, 4-5 Jun 45. 

117 Charles E. Kossman, Some Limitations of the Electrocardiogram in the Physical Examination for 
Flying, AAFSAM Project No. 8, 15 Feb 42. 

118 Charles E. Kossman, Physical Defects in Civilian Applicants for "Trainee Instructor": Relation to 
Flying Safety, AAFSAM Project No. 161-2, 8 May 44. 

119 R. F. Rushmer, A Study of the Valsalva Procedure by Means of the Electrocardiograph, Areterio- 
graph, and Teleroentgeno graph, AAFSAM Project No. 1 16-k, 2 Feb 43. 

180 This section is based on P. V. Karpovich, and Maj. B. E. Phillips, "Research in Physical Fitness," 
Rpt No. 19, Professional History. 

181 AAF Memo. 80-10 for C/AS, Hq AAF, Wash., D. C, 26 Jan 44; 2. P. V. Karpovich, Research in 
Physical Fitness, 6 Mar 46. 

182 Peter V. Karpovich, Appraisal of the Present Physical Training Program for Aviation Cadets, 
AAFSAM Project No. 15-1,2 Apr 42. 

388 Peter V. Karpovich, Development of Special Aviation Exercises, AAFSAM Project No. 26-1, 24 
Apr 43. 

184 AAF Regulation 50-10, "Training-Physical Fitness Test," Hq. AAF, Wash., D. C, 3 Feb 44. 

185 P. V. Karpovich, The Reliability of the AAF Physical Fitness Test, AAFSAM Project No. 184-1, 
20 Oct 43. 

*" Ltr., C/Research Div., OfT. of TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 27 Apr 43- 
WI P. V. Karpovich, Relation Between Breath Holding and the Endurance in Running and Harvard 
Step-up Tests Scores*, AAFSAM, Project No. 373-2, 7 Nov 45. 

188 R. R. Ronkin, Further Studies on the Harvard Step-up Tests, AAFSAM Project 148-2, 17 Aug 44. 

189 R. R. Elbel and R. R. Ronkin, Palmar Skin Resistance as a Measure of Physical Fitness, AAFSAM 
Project No. 31 9-1, 18 Jul 45. 

190 Ltr., Exec. Research Div., OfT. of TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 9 Dec 43. 
181 P. V. Karpovich, Physical Fitness for Convalescents, AAFSAM Project No. 225-1, 14 Jun 44; 2. P. V. 

Karpovich, Analysis of the Pulse Reactions in the Red Step-up Test, AAFSAM Project No. 224, 2, 12 Aug 
44; j. E. R. Elbel and E. L. Green, Pulse Reaction to Performing Step-up Exercise on Benches of Different 
Heights, AAFSAM Project No. 246-4, 25 Jan 45. 

192 H. D. Kingsley, and R. F. Rushmer, Effects of Abrupt Deceleration on the Electrocardiogram 
{Lead II) in the Cat in the Supine Position, AAFSAM Project No. 450-1, 21 Jan 46. 

198 R. F. Rushmer, A Study of the Role of Intra- Abdominal Pressure in Tolerance to Centrifugal Force, 
AAFSAM Project No. 316, 9 Sept 44; 2. R. F. Rushmer, The Changes in Pressure in the Peritoneal Cavity 
Produced by Sudden Deceleration of Experimental Animals, Project No. 472-1, Apr 46. 

194 See n. 193. 

198 R. F. Rushmer, C. H. Coles, T. Martin, J. J. Tucker, "Crash Injuries of Experimental Animals" 
(Motion Picture), released by Photo Engineering Br., Tech., Data Lab., ATSC, Wright Fid, Ohio. 

""This section is based on Maj. R. H. Broh-Kahn, "Research in Bacteriology and Preventive Medicine,'* 
Rpt No. 18, Professional History. 

197 Long distance telephone conversation between Maj. A. C. Van Ravenswaay Off. of TAS, and Maj. 
R. H. Broh-Kahn, C/Lab. Service, AAF Regional Hosp., Scott Fid, 111., 24 Jan 45. 

198 In the Diarrheal Control Program to supervise the work of the Central Diarrheal Disease Control 
Program Laboratory. 

199 M. J. Romansky and G. E. Rittman, "Penicillin I. Prolonged Action in Beeswax -pea nut Oil Mixture. 
2. Single Injection Treatment of Gonorrhea," Bull. V. S. Army Med. Dept., No. 81 (1944), 43~49- 

5,00 Ltr., C/Lab. Service AAF Regional Hosp., Scott Fid, 111., to Maj. A. C. Van Ravenswaay, Off. of 
TAS, Hq., AAF, Wash., D. C, sub: Studies of Penicillin Absorption, 10 Nov 44. 

Ltr., C/Lab. Service, AAF Regional Hosp., Scott Fid, 111., to Maj. A. C. Van Ravenswaay, Off. of 
TAS, Hq, AAF, Wash., D. C, sub: Treatment of Acute Gonorrheal Urethritis with Penicillin-Neosynephrine- 



350 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Dextrose Therapy, 20 Dec 44. This led Broh-Kahn to observe collaterally that "subsequent to the admin- 
istration of penicillin to a patient with gonorrhea, a state of remission is induced which often cannot be 
differentiated adequately from true cure and emphasizes the need for prolonged periods of observation 
in evaluating the success of treatment of gonorrhea by penicillin." Broh-Kahn, Rpt No. 18, Professional 
History, p. 1207. 

203 1st Ind. (Ltr. above), Hq. AAF, Wash,. D. C, to Comdt., AAFSAM, 4 Jan 46; 2. R. H. Broh- 
Kahn, et al. t The Effects of Total Dosage and Antacid on the Treatment of Gonorrheal Urethritis by Oral 
Penicillin. Unpub. MS. 

203 R. H. Broh-Kahn and P. K. Smith, The Biological Conversion of n-Butyl Penicillin, AAFSAM 
Project No. 389, 8 Nov 45. 

204 /. J- FusseU, H. F. Pedrick, and R. H. Broh-Kahn, The Penicillin Sensitivity of Hemolytic 
Streptococci Isolated from Human Throats, AAFSAM Project No. 469-1, 27 Feb 46. 

305 A. Bondi and C. C. Dietz, "Relationship of Penicillinase to the Action of Penicillin," Proc. Sec. 
Exp. Biol. & Med., LVI (1944), 135-137. 

206 1 st Ind. (Ltr., Comdt., AAFSAM to CG, AAF, Off. of TAS, sub: Role of AAFSAM in Diarrheal 
Control Program, 30 May 45), Off. of TAS, Hq., AAF, Wash., D. C, to Comdt., AAFSAM, 9 Jun 45. 

20T P. R. Edwards and R. H. Broh-Kahn, The Serological Identification of Salmonella Cultures, 
AAFSAM Project 45i-i> 28 Sept 45. 

208 Ibid. 

209 R. H. Broh-Kahn, R. B. Mitchell and S. J. Yosim, Salmonella Types Isolated from Presumably 
Healthy AAF Combat Returnees, AAFSAM Project No. 475, May 46. 

210 R. B. Mitchell and R. H. Broh-Kahn, An Outbreak of Foodborne Gastroenteritis Caused by 
Salmonella Pullorum, AAFSAM Project No. 450, 20 Sept 45. 

211 4 th Ind. (Ltr., Dir/ Research, AFTAS, to Comdt, AAFSAM, 16 Sept 44), AFTAS to Comdt., 
AAFSAM, 17 Nov. 44. 

212 Based on G. M. Hass, "Medical Aspects of Aircraft Accidents," Rpt No. 20, Professional History. 

213 Memo, for Comdt., AAFSAM, from Surg., AAF, CGTC, Randolph Fid, Tex., 43. 2. Memo, for 
Comdt., AAFSAM, thru: Dir/ Research, from Capt. George M. Hass, AAFSAM, 29 Oct 42. 

214 G. M. Hass, "Types of Internal Injuries of Personnel who have crashed in Aircraft Accidents," 
/. Avn. Med., XV (Apr 44), 77. 

215 Ltr., Actg Comdt., AAFSAM, to CG, AAF, Research Div., Off. of TAS, 4 May 43. 

2M 3 rd Ind. (basic ltr., TAS to Comdt., AAFSAM, 14 Jan 43), Comdt., AAFSAM to CG, AAF, Off. 
of TAS, 22 Jan 43. 

217 Memo, for Comdt., AAFSAM, from C/Pathology, AAFSAM, 29 Apr 44. 

218 G. M. Hass, Relations Between Time of Day, Nature of Aircraft Accidents, Types of Aircraft and 
Degree of Injury to Flying Personnel at Randolph Fid, Tex., AAFSAM Project No. 123, 26 Feb 43. 

219 G. M. Hass, The Relations Between Injuries duo to Aircraft Accidents at Brooks Eld, Tex., in 1942 
and the Causes and Nature of the Accidents, AAFSAM Project No. 144, 29 Apr 43. 

220 G. M. Has?, Relations Between Injuries to Occupants of Aircraft and the Time of Day which Air- 
craft Accidents of Various Types and Causes occurred at Broods Fid, Tex., in 1942, AAFSAM Project No. 
146, 5 Jun 43. 

221 G. M. Haas, The Relation Between Pilot Error and Multiple Aircraft Accidents, AAFSAM Project 
No. 153, 30 Jul 43. 

Tii G. M. Haas, "Relations Between Force, Major Injuries and Aircraft Structure with Suggestions for 
Safety in Designs of Aircraft," /. Avn. Med., XV (Apr 44); 2. "The Flight Surgeon's Reference File," 
AAF Manual 25-0-1, 1 Nov 45; 3. G. M. Haas, "Internal Injuries of Personnel Involved in Aircraft Acci- 
dents," Air Surg. Bull., I (Jan 44), 1. 

22a G. M. Hass, "Cranio-Cerebral Injuries of Personnel Involved in Aircraft Accidents," Presented to 
Assoc. Res. in Nervous and Mental Diseases, 16 Dec 44. 

224 Ibid. 

226 "Monthly Memo. Research Rpt," 1 Mar 45. 

226 "Monthly Memo. Research Rpt," 1 Apr 45. 

227 Memo, for Comdt., AAFSAM, from C/Pathology Dept., 19 Nov 45. 



RESEARCH AND DEVELOPMENT 



351 



228 G. M. Hass, An Analysis of Relations Between Force, Aircraft Structure and Injuries to Personnel 
Involved in Aircraft Accidents with Recommendations of Safer Principles of Design of Certain Types of 
Aircraft, AAFSAM Project No. 187, 1 Nov 43. 

229 See n. 227. 

230 G. M. Hass, A Study of Factors which Operate Against the Successful Escape of Occupants from 
Aircraft, AAFSAM Project No. 249, 5 May 44. 

231 Ibid. 

232 G. M. Hass, The Problem of Escape by Parachute in Acute Aerial Emergencies in Flying Training, 
AAFSAM Project No. 417, 5 Sept 45. 

23a 1st Ind. (basic ltr., Comdt., AAFSAM, to CG, AAF, Off. of TAS, 27 Nov 45), C/Med Research 
Div., Off., of TAS, to Comdt., AAFSAM, 18 Mar 45. 

234 This section is based on Capt. R. F. Rushmer, "Crash Injury Studies Using Experimental Animals," 
Rpt No. 11, Professional History. 

235 R. F. Rushmer, Internal Injury Produced by Abrupt Deceleration of Small Animals, AAFSAM 
Project No. 241-1, 2 Sept 44. 

23e R. F. Rushmer, Comparison of Experimental Injuries Resulting from Decelerative Forces Applied to 
the Ventral and Dorsal Aspects of Rabbits During Simulated Aircraft Accidents, AAFSAM Project No. 
301— 1, 8 Oct 44. 

237 See n. 195. 

23tf See: "A few highlights in the Army Career of Colonel Boynton," a brochure containing photostat 
copies of basic documents including W. D. General Ords. posthumously awarding him the Legion of Merit 
and the Distinguished Flying Cross; and also periodical and newspaper clippings. 



Chapter V 

AIR EVACUATION MISSION 



The origins of air evacuation of the sick and wounded by military air trans- 
port are rooted in the period when the Wright Brothers developed the airplane. 
The first known report of aircraft to be used in the transportation of patients 
was made by Capt. George H. R. Gosman (MC), and Lt. A. L. Rhoades, 
CAC, United States Army to The Surgeon General of the Army in 1910. These 
officers had constructed an ambulance plane at Fort Barrancas, Florida, and 
the first flight was made in 1910. Shortly thereafter Captain Gosman 
brought his report to Washington and endeavored to obtain funds from the 
War Department for the work of improving this plane and using it for carrying 
medical supplies and transporting patients. His mission failed, but he was, 
undoubtedly, the first to point out the great possibilities of the airplane for 
this purpose. Two years later, the use of airplanes for transportation of 
patients was recommended to the Secretary of War, but the airplane was not 
considered sufficiently improved for such use. 

During World War I, the airplane was used for the evacuation of casualties 
to a very minor extent. At best, the service type planes were far from satis- 
factory since a patient was, of necessity, wedged into the narrow cockpit of 
the open plane. 1 In February 1918, at Gerstner Field, Louisiana, Maj. Nelson 
E. Driver (MC), and Capt. William C Ocker, Air Service (at the Air Force 
was then known) converted a JN-4 ("Jenny") airplane, plane #3131, into an 
airplane ambulance. This plane was converted by changing the rear cockpit so 
that a special type litter with patients could be accommodated. These men are 
credited with the first transportation of patients in an airplane in this country 
and their work aided in demonstrating the practicability of transporting 
patients by air. At this time the use of the airplane ambulance, in relation to 
crashes, was stressed. The plane delivered a flight surgeon to the scene of 
the crash and then transported the casualties to the nearest hospital. This 
plane proved especially valuable in the southwest. 



[352] 




Early air evacuation planes. 




Early air evacuation planes. 



AIR EVACUATION MISSION 



357 



At Ellington Field, another airplane ambulance was constructed and com- 
missioned on i April 1918, using the plans of the first airplane ambulance at 
Gerstner. An improved type was soon designed at Ellington Field and com- 
missioned on 6 July 1918. This was the first plane in which the standard U. S. 
Army litter could be used. In July 1918 the Director of Air Service requested 
that a number of Curtis training planes be converted into airplane ambulances, 
and the transportation of patients from air fields to general hospitals was en- 
couraged throughout the Air Service, Two years later, in 1920, a specially 
designed airplane ambulance, the first plane in the U. S. Army to have a fuselage 
which was designed primarily for the transportation of the sick and wounded, 
was built and flown at McCook Field, Ohio. This plane, a DH-4 model, pro- 
vided space for a pilot, two litters (Stokes), and a medical attendant. Several 
more of these planes were constructed in 1920 for use on the Mexican border. 

Although airplane ambulances were in use in the United States following 
World War I, there did not appear to be any great need for air evacuation on 
a large scale during peacetime. In April 1921 considerable correspondence 
ensued concerning transportation of patients from Mitchel Field, Long Island, 
New York, to Boiling Field, Washington, D. C, with the view of transporting 
the patients to Walter Reed General Hospital. At this time the Army had 
Curtis Eagle airplanes which would accommodate four litters and six sitting 
patients. The request was indorsed favorably by Maj. Gen. M. W. Ireland, The 
Surgeon General, and Brig. Gen. William Mitchell. However, the War Depart- 
ment disapproved, stating transportation by this means was not justified as long 
as there were safer means available. Unfortunately for the progress of aerial 
evacuation, this most advanced airplane ambulance crashed while flying in a 
severe electrical storm in Maryland on 28 May 1921, resulting in the death of 
seven officers and men. This one untimely crash probably had a decided effect 
in delaying the development of aerial transportation of patients in the United 
States. 

In 1921 Major Epanlard of the French Army organized the first airplane 
ambulance organization consisting of six airplanes, each adapted for transport- 
ing two or three litter patients, for use in the Riffian War in Morocco. During 
these operations in 1922, more than 1,200 patients were evacuated by air. In 
1923 nearly 1,000 patients were evacuated without accident from forward strips 
near the Atlas Mountains, across desert regions, to the hospitals located near 
established bases far to the rear. This trip required a few hours instead of sev- 
eral days, and the airplane definitely proved to be superior to all other forms 
of transportation. Aerial transportation in this military operation not only 
conformed to the principle of early surgical aid for casualties but markedly 



358 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

reduced the problem of transportation. Picque predicted in 1924, that "in the 
future, hours will replace days in calculating the duration of wounded trans- 
port", and further illustrated the military and logistic advantages of aerial trans- 
portation of casualties in the following statement: "By rapidly removing the 
wounded from the fighting zone, the medical aeroplane has in a remarkable 
manner relieved the convoys, economized the fighting troops, and hastened 
the advance of attacking columns." 

There were comparatively few developments in air evacuation in the U. S. 
Army during the years 1920 to 1940, but the future use of air evacuation was 
anticipated. Col. Albert E. Truby (MC), in a paper written in 1922, pre- 
dicted that "airplane ambulances" would undoubtedly be used in the future 
for the following purposes : 

(1) At training fields and other Air Service Stations for taking medical 
officers to the site of crashes and bringing casualties from the crash 
back to hospitals at home stations; 

(2) For transporting patients from isolated stations to larger hospitals 
where they can receive better treatment; 

(3) For use at the front in time of war in transporting seriously wounded 
to hospitals on the line of communications or at the base; 

(4) For the transporting of medical supplies in emergencies. 

In 1929 Maj. Robert K. Simpson (MC), advocated the use of large transport 
planes which could be converted to accommodate litters for the purpose of 
evacuation of casualties in the event of a future war. He emphasized the speed 
and comparative comfort to the casualty of such transportation and stated that 
treatment of an emergency nature could be instituted while in flight. Simpson 
further predicted that evacuation by plane would be a very important factor 
in handling the wounded of the next war, if not the method of choice altogether, 
and recommended that tentative plans should be made toward the establish- 
ment of the airplane ambulance as an adjunct to the Medical Department. At 
the time, the Army Air Corps had three Cox-Klemun type air ambulance planes 
in addition to a number of passenger type transport planes which were used 
as patient carriers in emergency. The contemporary Douglas type transport, 
when converted, would carry four litter patients. 

In April 1930 an airplane described as "the largest and most complete air- 
plane ambulance ever designed" was used in the annual field exercises of Air 
Corps Combat Units and was considered to be a long step toward the ultimate 
airplane ambulance. This plane was a tri-motored Ford Transport which would 
accommodate six litter patients, in addition to a crew of two pilots, a flight 
surgeon, and a medical technician. Medical equipment in the plane included 
instruments, drugs, splints, and dressings for emergency supportive treatment. 



AIR EVACUATION MISSION 



359 



Following the First Air Division Maneuvers in May 1931, in which 672 
planes and more than 1,500 flying personnel participated, Maj. C. L. Beaven 
(MC), recommended the use of two large transport type planes, capable of 
transporting six litter patients, and two small two-litter planes for air ambulance 
use in future peacetime maneuvers of this size. All patients requiring 
evacuation over an appreciable distance during these maneuvers were trans- 
ported by aircraft. The recommendation also suggested that the autogyro air- 
plane be considered for use in rescue work following airplane crashes. In 1935 
Beaven recommended that the Army adopt two types of airplane ambulances 
for peacetime as well as war use: a small or rescue type, and a large transport 
type. The rescue type was to be capable of landing and taking off in small 
emergency fields and transporting two litter or two sitting patients, plus pilot 
and flight surgeon. The recommendations for the larger transport type airplane 
ambulance included water, toilet facilities, and a cabinet for instruments, utensils, 
dressings, blankets, and baggage. Beaven cited the successful use of air evacua- 
tion by the French in Morocco and by the U. S. Marines in Nicaragua as evidence 
of the practicability of this type of evacuation and was of the opinion that a 
great opportunity existed for the use of the ambulance airplane in evacuating 
casualties from the infantry division in combat. 

In the Spanish Civil War (1936-1938), the German Air Force had the op- 
portunity to demonstrate the military feasibility of aerial evacuation of the 
sick and wounded over great distances. They transferred Nazi casualties of the 
Condor Legion in Ju-52 model transport planes which were capable of carry- 
ing six litter and two ambulatory patients when auxiliary cabin tanks were used. 
Stripped of these tanks, the planes could accommodate ten litter and eight 
ambulatory patients. Flights were made from Spain across the Mediterranean 
to Northern Italy and then over the Alps at altitudes up to 18,000 feet. Total 
distances traveled varied from 1,350 to 1,600 miles and the average duration 
of flight was 10 hours. With the experience gained in this conflict, the German 
Army was able to initiate an air evacuation program at the onset of war with 
Poland. In 1939, during the first six weeks of the Polish campaign, 2,500 patients 
were evacuated to hospitals in Germany with only four deaths occurring in 
flight. In 1939 and 1940, during the Russian campaign in Finland, air evacua- 
tion was used from Russian divisional hospitals to base hospitals. These demon- 
strations in combat were to prove of considerable value to the Allies during 
the course of the war. The implications of these lessons were not lost upon a 
young American doctor then studying in Germany, Dr. Richard Meiling. Upon 
his return to the United States, he was to be commissioned in the Army and 



360 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

later to become the first and only "Air Evacuation Officer" in the Office of the 
Air Surgeon. 2 

In 1940 Headquarters AAF seriously reviewed the use of the airplane for 
evacuation of casualties and proposed the organization of an ambulance bat- 
talion to consist of an Air Transport Group together with medical personnel. 2 
The basic medical unit of this battalion, the Medical Air Ambulance Squadron, 
was authorized in T. O. 8-455, dated 19 November 1941, and called for a group 
composed of four squadrons, one headquarters squadron, and three airplane 
ambulance medical squadrons. Two of the ambulance squadrons were to con- 
tain twelve bimotor ambulance planes similar to the DC-3 commercial trans- 
port. The other ambulance squadron was to have eighteen single engine ambu- 
lance planes, similar to the newly developed liaison plane (the L-i type plane). 
The unit was to be placed under the control of General Headquarters in a 
theater, being attached to subordinate commands as dictated by the situation, 
and was to augment surface transportation. Lt. Col. David N. W. Grant 
(MC), Chief, Medical Division, Office, Chief of Air Corps, pointed out 
at this time that the proposed organization "would lighten and speed the task 
(of transporting casualties), due to its extreme mobility, and would be able to 
render service at a time and place where other means of transportation are rela- 
tively at a minimum." 3 

It was in the prewar Air Force Combat Command, however, that the 
logistical value of air evacuation to a tactical Air Force took on practical mean- 
ing. The Army Medical Department did not at this time envisage the 
airplane as a substitute for field ambulances and as a result during the Carolina 
and Louisiana Maneuvers the lines of evacuation over the long, isolated stretches 
became over-extended with proper medical care not always immediately avail- 
able. This was exactly the situation that Maj. I. B. March had foreseen back 
in the middle 1920^ when he had written that if a separate Air Corps were 
to be established it should provide its own air evacuation system. Now, as 
Surgeon for the Air Force Combat Command, it was apparent to him that 
the aerial paths of a tactical Air Force could not be fully supported by motor 
vehicles which could not cover the wild and uninhabited terrain over which 
a plane could fly. He reaffirmed his basic views to Lt. Col. Malcolm C. Grow, 
the Surgeon, Third Air Force, who was in position to watch the maneuvers 
first hand. In reply Colonel Grow wrote: 4 

I will push the idea of having hospital units with Air Forces and also do what I can 
to promote air-ambulances evacuation. I agree that the use of transport and cargo planes 



AIR EVACUATION MISSION 



361 



is not at all satisfactory and due to the wide dispersion of the Air Forces, ground ambulances 
present many difficulties as an agency in evacuation. I believe our chief stumbling block 
in the way of ambulances has been the lack of interest on the part of the Surgeon General. 
After all, the evacuation not only of the ground troops, but also the Air Corps casualties 
are the problem of the Surgeon General and until he accepts the airplane as a vehicle 
I doubt if very much can be done about it. 

Within 3 months the country was at war and it had become a matter of 
military expediency to evacuate patients by air even though it was not an 
accepted practice. 

The first occasion for mass movement of patients occurred in January 1942, 
during the construction of the Alcan Route in Alaska. In this case, trans- 
portation of casualties by air became necessary due to the fact that surface 
transportation was not available, and C-47 type aircraft were utilized in evacuat- 
ing these patients over long distances to fixed medical installations. The medical 
personnel involved in this operation were largely untrained and on a voluntary 
basis. No records were kept as to how many patients were evacuated during 
this operation. 

The second mass evacuation of personnel by air, utilizing Army Air Forces 
planes, occurred in Burma in April 1942. Ten C-47 aircraft evacuated 1,900 
individuals, some of whom were sick and wounded, from Myitkyina, Burma, 
to Dinjan, India, in a 10-day period. 

In May 1942 the Buna-Gona Campaign marked the beginning of a counter- 
attack against the Japanese in New Guinea. In that mountainous and jungle 
terrain, using surface means, many days of travel would be required to evacuate 
patients to Port Moresby ; but by air, it was a flight of approximately 1 hour over 
the Owen-Stanley Range. A total of 1,300 sick and wounded Allied troops were 
flown over this route during the first 70 days of the campaign. 

In June 1942 the 804th Medical Air Evacuation Squadron arrived in New 
Guinea to aid in the air evacuation operations. In late August 1942 Marine Air 
Transport and in September 1942 the AAF Troop Carrier Transport units began 
to evacuate patients from Guadalcanal to rear bases in New Caledonia and the 
New Hebrides; 12,000 casualties had been evacuated by air by the end of 1942. 




Interior of plane, showing four Hers of litters. 



366 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



The 349th Air Evacuation Group 

On 18 June 1942 the AAF was given responsibility for developing an air 
evacuation system and primary planning responsibility delegated to the Air 
Surgeon. The previous day, Col. Wood S. Woolford (MC), Surgeon of the 
I Troop Carrier Command, had reported to Headquarters, AAF, where he was 
instructed by the Air Surgeon "to give some thought to the matter of battle 
casualties". 5 

The logistical principles upon which the system would be developed were 
soon decided. There was a pressing need for transport planes capable of mass 
evacuation; yet there was an acute shortage of aircraft which made it imprac- 
ticable to use a single-purpose airplane ambulance at that time. 6 Early 
operational experience had already demonstrated that regular transport planes 
using removable litter supports (brackets), designed for that purpose, could be 
successfully used for air evacuation as well as for transporting materiel and 
combat troops to theaters of operations. Thus it was that the AAF came to 
decide that troop and cargo airplanes would have not only their primary 
mission, but the secondary mission of providing air evacuation. 7 

Facing the AAF also was the problem of determining the pattern of 
organization and training for air evacuation units. On 25 May 1942 the 
Army Air Forces had activated the 38th Air Ambulance Battalion at Fort 
Benning, Georgia, 8 which had immediately begun its training. It was an inde- 
pendent unit under the command of the 4th Headquarters Detachment, 
Second Army, Headquarters, Atlanta, Georgia. The personnel of the cadre 
consisted of a commanding officer and 17 enlisted men. 9 

Because of the proximity of Bowman Field, Kentucky, to I Troop Carrier 
Command Headquarters in Indianapolis, Indiana, it was decided to establish 
a training program there and to use the 38th Air Ambulance Battalion 
organization as the nucleus for the first unit. On 28 September 1942 the 
squadron, now consisting of 138 enlisted men and 2 officers, reported to Bowman 
Field, Kentucky, and was attached to the base hospital. 10 Soon after its arrival 
it was assigned to I Troop Carrier Command. On 1 October 1942 the squadron 
was redesignated the 507th Air Evacuation Squadron (Heavy) and directed 
by Troop Carrier Command to prepare for air evacuation of cattle casualties. 11 
As formerly planned for the Air Ambulance Battalion, the 349th Group was 
assigned two "heavy" squadrons, with twin engine transport planes and one 
"light" squadron with single engine planes. The unit was hurriedly trained, 
and from it 6 nurses and 15 enlisted men were used with 2 flight surgeons in the 
Texas Maneuvers. 12 



AIR EVACUATION MISSION 



367 



Troop Carrier Command had requested that the training in air evacua- 
tion be continued at Bowman Field, since it was believed that the area of the 
base formerly used by the Medical Officer's Training School would be an 
ideal location for this new school. Surveys made by the Engineering Section 
revealed that it would be necessary to enlarge the training area and provide 
barracks for nurses in addition to an administration building and classroom. 
Since the first squadron was to begin immediate training, this work had to be 
given a high construction priority. It later became necessary to borrow funds 
allotted to the Aero Medical Laboratory and request the highest possible pri- 
ority to complete construction in time to run the school at full strength. 13 

The work of organizing air evacuation activities at Bowman Field went 
forward rapidly. The 349th Air Evacuation Group, Headquarters and Head- 
quarters Squadron, was activated on 6 October 1942. 14 The group consisted 
of 9 medical officers, 1 Medical Administrative Corps officer and 2 nurses in 
addition to the enlisted men. 15 On 11 November 1942 the 620th and 621st Air 
Evacuation Squadrons (Heavy) and the 622nd Air Evacuation Squadron 
(Light) were activated. These three units were assigned to the 349th Air 
Evacuation Group. 16 All these activities, it should be noted, went forward 
independently of The Surgeon General. 

In late November 1942 the War Department directed the 349th to train 
flight surgeons, flight nurses, and enlisted personnel for air evacuation duty 
aboard troop and cargo carriers, and authorized a new table of organization 
for the basic unit, the Medical Squadron Air Evacuation Transport (T. O. 
8-447, 3° November 1942), This Table of Organization set up the squadron 
as a unit composed wholly of medical personnel, having no planes assigned. 
Each squadron was to consist of a headquarters section and four evacuation 
flights. The headquarters, or "housekeeping" section, would include the 
Commanding Officer, Chief Nurse, and the Medical Administrative Corps 
officer. Each flight, headed by a flight surgeon, was to have 6 flight nurses and 
6 medical technicians, 1 nurse and 1 technician making up a flight team. 
Squadrons were each to be assigned either to Troop Carrier or Air Transport 
Groups, many of which were already operating in various theaters. Where 
there would be need for units smaller than a squadron, individual flights could 
be assigned to Troop Carrier or Air Transport units. In accordance with the 
new Table of Organization, a reorganization of air evacuation activities took 
place on 10 December 1942, a reorganization which was accompanied by an 
expansion of air evacuation activities. 

The early training afforded these units was haphazard and consisted of 
basic training, squadron administration, the use of the litter, and the loading of 



368 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 

air evacuation aircraft. A didactic course of study was not established until 
January 1943. All personnel, with the exception of the 801st and 802nd Med- 
ical Squadrons, Air Evacuation Transport, who were trained by the 349th Air 
Evacuation Group, were graduated subsequently from the School of Air Evacu- 
ation. The personnel of the 801st and 802nd Squadrons were not so graduated 
because the training of these units was necessarily meager and totally inade- 
quate compared with the training given squadrons after January 1943. 17 

On Christmas Day 1942 the first of the squadrons departed for the North 
African Combat Zone. Thereafter similar units followed to every area where 
American fighting men were engaging the enemy and to overseas stations 
along the global air routes of the Air Transport Command. 

The Flight Nurse 

It was during this period that there emerged the counterpart of the flight 
surgeon — the flight nurse. It appears that credit for the original idea of the 
flight nurse belongs to Miss Lauretta M. Schimmoler, who as early as 1932 envi- 
sioned the Aerial Nurse Corps of America. 18 Miss Schimmoler suggested that 
there be established an organization composed of physically qualified and tech- 
nically trained registered nurses who would be available for duty in "air trans- 
ports" and "air ambulances," as well as "other aviation assignments." 19 Among 
the immediate objectives of these nurses was "To improve and increase air 
ambulance service over the country, including making available to the medical 
profession proper and adequate air nursing facilities, with special attention to 
proper protection for patient, pilot, and other passengers." 20 In October 1937 
there was an exchange of letters between Miss Schimmoler and General Arnold, 
then Chief of the Air Corps, when she sought recognition of her organization. 
Colonel Grow, then Chief of the Medical Section, after contacting the Nursing 
Division of The Surgeon General's Office, drafted a reply for General Arnold's 
signature which advised Miss Schimmoler to coordinate her project with the 
Red Cross. 21 A copy of Army Regulation 850-75 was included for her informa- 
tion concerning the Nurse Corps of the Army. 

In answer, Miss Schimmoler stated that the Aerial Nurse Corps had main- 
tained copies of AR 850-75 for the past three years; that she had discussed 
her project with the Red Cross in previous years and that "the personnel in 
office at that time were not air minded and could not see the need for nurses so 
educated," and that in subsequent contacts with the Red Cross she had 
found no change in this attitude. It was in terms of these experiences that she 
was approaching them "from other angles and through individuals such as your- 



AIR EVACUATION MISSION 



369 



self, who could show . . . where such a service would be of value to them . . ." 22 
When, for example, Miss Schimmoler advised the National Director, Nursing 
Service, American Red Cross, by letter as early as 9 January 1933 concerning her 
projected organization and its functions, 23 she was advised that "There would 
seem no point in making an attempt to organize a special group of nurses for 
this [Emergency Flight Corps] purpose." 24 Subsequent correspondence indi- 
cates that the Red Cross maintained this attitude until 1940. 25 Nevertheless, 
General Arnold insisted it was still necessary that "not only should members 
be individually a part of the Red Cross, but that your entire organization must 
needs be incorporated in or acting closely with and under supervision of the 
American Red Cross . ..." 26 

By 1940, however, the activities of the Aerial Nurse Corps had been suffi- 
ciently publicized so that many inquiries were being directed to the Army Nurse 
Corps and the Red Cross Nursing Service asking for information concerning 
this group. Answers to these inquiries' reveal an official attitude of opposition 
to the organization and a singular lack of imaginative foresight concerning the 
possibility of the future use of the airplane in the evacuation of the wounded. 
For example, as late as June 1940, the Acting Superintendent of the Army 
Nurse Corps stated: "The present mobilization plan does not contemplate the 
extensive use of aeroplane ambulances. For this reason it is believed that a 
special corps of nurses with qualifications for such assignment will not be 
required." 27 

By the latter part of 1940, however, Miss Mary Beard, Director of the Red 
Cross Nursing Service, after having carried on considerable correspondence 
with the officers of the Aerial Nurse Corps and other interested aviation groups, 
paid recognition to the founder of the Aerial Nurse Corps in these words: "Miss 
Schimmoler ... is one of those promoters who frequently establish some- 
thing which is needed, and which turns out in the end to be much better than 
one would have expected it to be in the beginning." 28 But in the same letter 
there is this important admission on the part of Miss Beard: 29 

No one of our nursing organizations, no leading school of nursing, nor any other professional 
group, has taken up this subject seriously and definitely tried to promote the organization 
of a group of nurses who understand conditions surrounding patients when they are travel- 
ing by air. Nor has the Army, the Navy, or the Red Cross done this. 

The general lack of enthusiasm among medical officers including those 
serving with the Air Corps is illustrated by the following quotations. Maj. Gen. 
C. R. Reynolds, The Surgeon General, said, "If commercial aviation companies 
require special nurses in any way, which at present I can't visualize, this is a 
matter which has nothing to do with the Medical Department of the Army." 30 



370 MEDICAL SUPPORT OF THE ARMY AIR FORCES IN WORLD WAR II 



Lt. Col. R. J. Piatt, Assistant Chief of the Medical Section, advised : "The Army is 
not building any hospital airships, nor airplane ambulances. When necessary to 
transport ill or injured Army personnel, transport or bombing type airplanes are 
used. Nurses are not used on these planes." 31 Col. W. F. Hall, Medical Sec- 
tion, stated in 1939: "They [nurses] are not required to be, nor is it deemed neces- 
sary that they be, assigned to the Air Corps for the rendition of nursing service in 
the air, inasmuch as enlisted men in the Medical Department are taught first 
aid. . . 32 And as late as 12 July 1940 the Chief of the Medical Division 
expressed this opinion: "It is not believed that in time of war, as a routine 
measure, nurses will be used on airplane ambulances." 33 

General Arnold received another communication from the founder of the 
Aerial Nurse Corps of America dated 19 October 1940, in which he was advised 
that the organization had recently been recognized by the California State 
Nurses' Association, and it was suggested that he keep her group in mind in 
connection with the development of the air ambulance battalion which had 
been announced in the press. She asserted her willingness to continue to follow 
his recommendations as she had done since 1937. 34 

It remained, however, for General Grant, as Air Surgeon, to later under- 
stand and develop the concept of the flight nurse as a part of the medical team. 
It is true that the times were right to develop the role of the flight nurse, just 
as in World War I the times were right for the idea of the flight surgeon to 
become a reality. Nevertheless it does appear that without the dynamic personal 
interest of the Air Surgeon in furthering the professional status of the nurse 
within the field of aviation medicine that the military indifference could not 
have been so successfully overcome to the degree that it was during the war. 
On 30 November 1942 an urgent appeal was made for graduate nurses, such 
as airline hostesses, for appointment to the Army Nurse Corps and subsequent 
assignment to the Army Air Forces Evacuation Service. 35 On the same date 
the Air Surgeon's Office initiated an Adjutant General's Memorandum setting 
out the qualifications for this service. 36 This policy remained in effect until 
War Department Circular No. 98, of 29 April 1944, delegated to the Command- 
ing General, Army Air Forces, the authority to prescribe the qualifications of 
the "flight nurses." 37 

On 18 February 1943 the first formal graduation of nurses of the 349th 
Air Evacuation Group was held at the base chapel. The 39 members of 
this group, which included many former airline hostesses, had been poorly 
housed and had completed a program of instruction that was definitely in the 
experimental stage. The 4 week's course included some class work in air 
evacuation nursing, air evacuation tactics, survival, aeromedical physiology, and 



AIR EVACUATION MISSION" 



371 



mental hygiene in relation to flying. In addition, the nurses received some train- 
ing in plane loading procedures, military indoctrination and a one-day bivouac. 38 

Brig. Gen. David N. W. Grant, the Air Surgeon, said in his address 
to this first graduating class: "Your graduation in the first class of Nurses from 
the first organized course in air evacuation marks the beginning of a new 
chapter in the history of nursing . . . Air Evacuation of the sick and wounded 
is already an accomplished fact requiring onl